Red spots on the skin and neck are harmless in most cases and often occur in the context of nervousness or allergies. However, sometimes serious infections can be hidden behind the red spots, which then require therapy. In order to distinguish between harmless spots and those requiring therapy, it is important to have them examined by a doctor.
It is important to pay attention to the appearance of the spots, for example whether they are raised or flat, symmetrical or asymmetrical; how long the spots have been present and whether similar symptoms have been present in the past. Other points that are important for differentiating between harmless and needing therapy are questions about itching or burning, the exact localization and whether self-therapy has already been initiated, for example, whether ointments or medications have already been used and whether there has been improvement or deterioration of the stains as a result. Spots localized on one side, especially on the hands (see also skin rash on the hands) or on the décolleté, often indicate allergic reactions to environmental stimuli such as perfumes, soaps or even jewelry, e.g. nickel.
These are usually associated with a burning or itching sensation and disappear when the source of irritation is removed. Bilateral skin rashes on the other hand usually indicate a skin disease or internal diseases. In addition, many patients also suffer from pigment disorders of the neck, which are usually harmless and do not indicate an existing disease.
Definition
Red spots are redness or pustules/pimples on the skin, which can be punctiform or extensive. In most cases these red spots are harmless. In some cases, however, they can also be the expression of various bacterial or viral infections or reactions to certain allergens.
Causes for red spots on the neck
Causes of red spots on the skin and neck can be stress and nervousness, skin diseases such as acne, infections such as Lyme disease and shingles or allergic reactions. In babies and children, red spots can stand for congenital skin symptoms such as naevus flammeus or infections such as measles, rubella, scarlet fever or chickenpox. In most cases, red spots on the neck or décolleté are banalities.
They often occur, for example, as part of erythrophobia (the fear of blushing) as an expression of nervousness and excitement. Young people in particular often blush during a lecture and notice large red spots on their neck and décolleté. Noticing these spots usually leads to a feeling of shame and further excitement, which one tries to avoid the next time.
A fear of (another) blushing develops. But since these red spots are caused by a physical reaction to nervousness, they are difficult to prevent. This in turn means that the red spots will reappear at the next exciting situation.
Behind the physical reaction is the activation of the vegetative nervous system (sympathetic nervous system), which in turn is accompanied by increased blood circulation and dilation of capillary blood vessels, which then leads to reddening and the formation of red spots on the neck and décolleté. Possibilities to avoid the formation of these spots include autogenic training for relaxation, the attempt to direct one’s concentration from the spots to other unimportant things, cosmetic products to cover the redness and in severe cases psychotherapy. Alcohol can also cause a dilatation of the capillary vessels, increased blood circulation and thus blushing, especially when drinking champagne or wine.
Systemic infectious diseases that can manifest themselves with red spots on the skin include borreliosis, syphilis, hepatitis and shingles. In Lyme disease, a ring-shaped, bright red skin rash typical of the disease is found, the center of which has faded and which slowly spreads in a circular pattern from the tick bite site. This rash is also called erythema migrans (“wandering redness”) due to its “wandering” nature.
Syphilis, a common sexually transmitted venereal disease, is characterized by a typical, small spotted red exanthema (rash) in the advanced stage, which spreads over the entire body, especially over the palm of the hand and the soles of the feet.Hepatitis manifests itself, among other things, with large red spots on the palms of the hands, and shingles has a red, pimply rash that is dermatome-related, i.e. limited to certain areas of skin innervated by nerves. Typical skin diseases associated with red spots include scabies, fungal diseases, acne vulgaris, neurodermatitis, rosacea and psoriasis. The most common skin disease in Germany is acne vulgaris, which can occur in various aggressive forms and typically affects adolescents in their puberty and ceases to exist in adulthood.
Classical symptoms of acne are comedones (“blackheads”), as well as inflammatory red spots and pimples (so-called pustules, nodules and abscesses) in the course of the disease, which mainly affect the face, décolleté, back and shoulders. Atopic dermatitis is characterized by small, dot-shaped, red spots and pimples (vesicles) on the elbows, back of the knee and hands, which can become encrusted and weeping and which are also extremely itchy. Neurodermatitis can already affect infants and manifests itself there via the so-called milk crust – this refers to very itchy lumps and blisters that crust and scale and are typically found in the head and neck area.
The name comes from the similarity of the spots to the color of burnt milk. Rosacea is a chronic inflammatory skin disease of unclear cause, which can be triggered by various stimuli such as alcohol, stress and UV light. It is characterized by spotty skin redness and dilated veins, so-called telangiectases, on the forehead, nose and cheeks.
In the course of the disease, pus blisters and persistent redness of the skin (erythema), nodules and finally, especially in men, a nodular appearing enlarged nasal change (rhinophyma) may occur. Similar changes can also occur at the root of the nose, on the ear or on the chin. Scabies, also known as scabies, is a sexually transmitted disease caused by the scabies mite and can be transmitted to other people through direct physical contact (including sexual intercourse or when children play together).
Typically, in addition to severe itching at night, there are elongated, red, raised spots (papules) that burn and may later become encrusted. Typical predilection sites are finger and toe gaps, axillary folds, nipples, wrists and the male genital. Other parasites such as fleas or lice can also cause punctiform rashes in the area of the décolleté, the armpits or the pubic region, among others.
Fungal diseases, such as candidiasis (caused by the yeast fungus Candida albicans) are often found in weeping skin folds or, depending on the pathogen, also in the hair of the head or on the entire body. Typical here are large, itchy, red rashes with scaly edges. Allergic reactions often manifest themselves with itchy or burning red spots and are usually a defensive reaction of the body to a certain environmental stimulus.
Typical triggers can be cold, pollen, but also cosmetics, soaps, drugs or chemicals. Red spots on the skin can also occur in the context of a sun allergy. Stress, nervousness and psychological strain increase the sympathetic tone.
The sympathetic nervous system is an (autonomous) nervous system that cannot be consciously controlled. In strenuous situations, during sports or stress, for example, it makes the heart beat faster and increases blood pressure. As a result, the body is better supplied with blood and oxygen.
At the same time, the blood vessels dilate so that the blood, which is pumped more frequently through the heart, can reach the muscles more easily. The vessels that lie just under the skin also dilate. If these are noticeable as red spots on the neck, face or décolleté, this is also known as “flushing”.
Since the skin on the face, neck and décolleté is relatively thin, these areas of the body become particularly noticeable in stressful situations with red spots. These dilated and more strongly supplied with blood vessels are particularly noticeable in light skin types. If itching red spots appear on the neck after hours or even days, it may be a sun allergy (polymorphic light dermatosis).
The cause of a sun allergy is still unknown. However, the sun allergy often occurs in people who generally have sensitive skin. In addition to the red spots, small blisters or nodules (papules) may appear, which remind one of an allergic reaction of the skin.In addition to the neck, the face, décolleté, hands and arms are often affected – areas of the body that are usually exposed to sunlight for longer periods.
In order to prevent a sun allergy, a longer stay in the sun should be avoided. In any case, a sunscreen for sensitive skin should be applied before every stay in the sun. However, red spots on the neck can also be caused by skin care products after sunbathing (for example after using après-sun lotion).
Red spots on the neck that appear after prolonged exposure to the sun can also be a sunburn. Red spots appear on the neck if, for example, the sunscreen has not been applied thoroughly enough and thus skin areas have been forgotten. This leads to a painful reddening, which subsides after about 2 days.
Just as with erythrophobia, red spots can appear on the face, especially on the forehead and cheeks, and on the décolleté even when drinking alcohol. In most cases, a few sips of wine or sparkling wine are enough for those affected to feel a reddening and warming of their face. An exact cause has not yet been described.
However, studies assume that those affected have a genetically determined ability to dilate their capillary vessels more quickly than others, resulting in increased blood flow with blushing. In addition, alcohol has the same effect on the blood vessels, which is why even small amounts of alcohol are sufficient for those affected to develop red spots and a flush. In some cases, allergies to alcohol have also been described, which are also accompanied by dilation of the blood vessels, a strong sudden flush and in severe cases breathing difficulties.
In the case of hyperthyroidism, there is an increased production of thyroid hormones, which leads to an increased sensitivity to catecholamines (stress hormones). This increased sensitivity leads to tachycardia, high blood pressure, increased blood circulation, heat intolerance and increased sweating. The increased blood circulation and heat intolerance ultimately also leads to the so-called “flush”, a blushing of the cheeks and décolleté. Thyroid hyperthyroidism can be treated with the help of thyrostatic drugs or radioiodine therapy.
