Infant Neck Rash

Dear Lisa,

My 9 month old daughter has a rash on her neck under her chin. It has been there for months and is not going away. Otherwise she has beautiful skin and has no rashes anywhere else on her body. Normally you can’t see the rash because she has a chubby neck. Every once in a while she stretches her neck and you can see it. I’ve tried putting different lotions and crèmes on it, but nothing seems to work. Sometimes milk drips down her neck but I make sure that I clean it all of the time. The rash doesn’t seem to bother her, but it bothers me because to strangers it looks like I don’t clean my baby. Every time we go to a relative’s house, she stretches her neck and everyone sees it. I keep on forgetting to ask my Pediatrician to check it because it doesn’t bother her and it slips my mind when we are in the office. Have you ever seen babies with a rash under the neck that won’t go away? What can this be from?

“Baby with Rash Under the Neck”

Dear “Baby with Rash Under the Neck”,

From your description it sounds like your baby may have Intertrigo. Although the best way to identify a rash in a child is to see your Doctor or Nurse Practitioner. Intertrigo is a common rash found in infants. Babies with chubby necks tend to get Intertrigo because the rubbing of the opposing skin causes the irritation that breaks down the skin. Intertrigo is also exacerbated by chafing and moisture. Intertrigo can be found in parts of the body where skin rubs together such as under a baby’s neck, under the arms, on the buttocks, in the groin area and in the skin creases of chubby legs. (1) The rash appears as a red maceration and at times may appear to ooze clear fluid.

Basically Intertrigo is a benign condition that will go away on its own in time. The treatment for the condition is exposure to air, elimination of moisture and avoidance of irritating clothing. (1) This sometimes is impossible in a baby that doesn’t move, tends to drool a lot and is a messy eater. As a baby grows and develops, less food drips down their neck, they tend to stretch their neck more to look upwards when learning to walk and the chubby area in the neck thins out. As a result there is less chaffing, less moisture and more exposure to air. Naturally the Intertrigo rash should go away on its own.

In the mean time it is important to keep the area as clean and dry as possible. Avoid clothing that rubs at the neck area. When bathing your child, make sure the area is dry and gently spread the skin folds with your fingers so that the area is exposed to air. It is best not to apply ointments because they tend to hold moisture which may encourage increased maceration. (1) Some practitioners may prescribe Caldesene powder because it may help dry the area, but I prefer to not use powder especially near a child’s face. The inhalation of powders by babies can be irritating to the lungs.

Since Intertrigo is a break in the skin integrity, occasionally a child can develop a super-infection with a fungus or bacteria at the site. Therefore if the rash seems to be spreading, develops an odor or crusting or if your baby develops a fever, it would be important to bring your daughter into the Doctor’s office for an evaluation. Candida Albicans, a fungal rash can commonly co-exist with Intertrigo therefore it would be a good idea to have your baby’s doctor look at the rash during your next scheduled visit. If the rash is infected with Candida Albicans your Doctor or Nurse Practitioner may prescribe an anti-fungal crème to apply to the area if necessary. (1,2)

Intetrigo is not caused by ineffective cleaning therefore you can be assured that it is not related to how you care for your baby. There is no reason to be embarrassed about the rash in front of your relatives. Instead, use the opportunity to educate them in regards to what Intertrigo is. On a positive note, skinny babies usually don’t develop Intertrigo, so look at it as a blessing that you have a thriving healthy child that is gaining weight.

References:
(1) Chow M, Durand B, Feldman M, Mills M. Handbook of Pediatric Primary Care. Albany, New York:Delmar Publishers Inc. 1984: 616.
(2)Cham P, Warshaw E. A lone superficial web-space erosion. The Clinical Advisor. 2006. July: 86-93.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice Updated Daily