Red Bumps on the Neck: Causes and Treatments

Rash resembling acne on the neck?

Hello Doctor: In January 2021, I suddenly developed red, pimple-like rashes on both sides of my neck that were itchy, prompting me to seek medical attention (I had never experienced this before).
I visited two clinics, and the doctors prescribed various ointments, but there was no improvement.
It took nearly three months for the condition to heal.
The doctors diagnosed it as herpes, folliculitis, acne, or irritation from wearing a mask, but they could not determine the underlying cause.
The doctors asked if I had consumed seafood, used makeup, smoked, stayed up late, or frequently ate meat or fried foods.
I informed them that I rarely eat seafood or meat, absolutely avoid fried foods, do not wear makeup, and go to bed by 10:30 PM.
However, my work environment is quite stressful, and I sometimes feel overwhelmed.
Recently, the condition has recurred; I have developed noticeable red, pimple-like rashes on both sides of my neck, which appear to have white pus inside.
They are not itchy or painful, but I feel a foreign sensation in my neck, and touching them causes mild pain.
This symptom has persisted for a week as of today, July 18, 2021.
Could you help me determine what this condition might be? Should I apply any specific ointment for treatment, or will sufficient rest allow my body to heal on its own? Thank you for your guidance.

Shangbanzu, 30~39 year old female. Ask Date: 2021/07/18

Dr. Wu Yuxin reply Dermatology

No lesions were observed, making it difficult to determine the issue.
If this is causing significant distress, please seek medical attention promptly.

Reply Date: 2021/07/18

More Info

Based on your description, it sounds like you are experiencing recurrent red bumps on your neck that resemble acne or folliculitis, which can be quite frustrating, especially since you've already sought medical attention without a definitive diagnosis. Let's break down the potential causes and treatments for your condition.

Possible Causes
1. Folliculitis: This is an inflammation of the hair follicles, often caused by bacterial or fungal infections. It can present as red, itchy bumps that may contain pus. Stress and friction from wearing masks or tight clothing can exacerbate this condition.

2. Contact Dermatitis: This occurs when your skin reacts to something it has come into contact with, such as soaps, lotions, or even fabrics. Given that you mentioned a high-stress work environment, it’s possible that stress could be contributing to skin sensitivity.

3. Acne: While typically associated with the face, acne can occur on the neck as well. Hormonal changes, stress, and even diet can play a role in acne flare-ups.

4. Herpes Simplex Virus: If the bumps are indeed vesicular (blister-like), they could be related to a herpes outbreak. However, this is less likely if the bumps do not itch or burn.

5. Heat Rash: If you are in a warm environment or sweat a lot, you might develop a heat rash, which can appear as small red bumps.

6. Stress-Induced Dermatitis: Stress can lead to various skin issues, including flare-ups of existing conditions or the development of new ones.

Recommended Treatments
1. Topical Treatments: Since you mentioned that various creams have not worked, consider asking your doctor about topical antibiotics (like clindamycin) or benzoyl peroxide, which can help with bacterial infections and acne. If it’s folliculitis, an antifungal cream may also be beneficial.

2. Oral Medications: If topical treatments are ineffective, your doctor might prescribe oral antibiotics or antifungals, depending on the diagnosis.

3. Avoid Irritants: Since you mentioned that the bumps may be related to friction from wearing masks, try to minimize irritation by using softer fabrics and ensuring that your clothing is not too tight around your neck.

4. Stress Management: Since you indicated that your work environment is high-pressure, incorporating stress management techniques such as mindfulness, yoga, or regular exercise could help improve your overall skin health.

5. Dietary Considerations: Although you mentioned you do not consume seafood or fried foods, consider keeping a food diary to identify any potential triggers. Some people find that dairy or high-sugar foods can exacerbate skin issues.

6. Consult a Dermatologist: If your symptoms persist or worsen, it may be beneficial to see a dermatologist who can provide a more specialized evaluation and treatment plan.

Conclusion
It’s understandable to feel frustrated when dealing with skin issues, especially when they recur. Given the complexity of skin conditions, a thorough examination by a healthcare professional is essential for an accurate diagnosis and effective treatment. In the meantime, focus on maintaining a gentle skincare routine, managing stress, and avoiding known irritants. If the bumps continue to cause discomfort or do not improve with over-the-counter treatments, do not hesitate to seek further medical advice. Your skin health is important, and finding the right solution can take time and patience.

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