Neck Rash or Intertrigo

It has been a rather warm winter throughout the country and because of this I have recently seen a few skin issues that are more commonly seen in the warmer months of the year.

One of these is intertrigo which is a skin condition that is often seen in infants who are chubby and have "no necks".  Because of this "no neck" phenomena, a baby's chin and lower jaw may rest right on the chest. When parents are bathing a baby they sometimes don't realize that you have to lift up the baby's chin and hyperextend the head to ensure that the skin folds around the neck are getting clean and staying dry. This is also true for skin folds under the arms, or in the inner thigh.

When the skin folds rub together the skin can break down and become red, raw and macerated.  If the moisture and rubbing are persistent the skin may even begin to weep a bit of yellowish fluid.

 Babies are constantly dribbling milk from their mouths onto their chins, and then the fluid runs right down and accumulates beneath the neck. On top of this moisture there is also perspiration, especially with warm weather, which accumulates in the skin folds. That is why intertrigo is more common during hot weather.

 I just saw a baby with terrible intertrigo and I think that her parents were dressing her in multiple layers (a T-shirt, flannel onesie and a blanket) and her neck was so inflamed and wet and weepy. I told her Mom that the first thing we needed to do was to take all of this off of her as she was overdressed and overheated. She just needed to be in a cotton gown as it was about 70 degrees outside.

The best way to treat intertrigo is to stretch out the neck after bathing and really dry it well. I evened used the blow dryer on warm on my own boy's necks so that I could make sure the skin folds were dry. If the area is still moist and starting to get inflamed I like to use Dommeboro soaks, which is soothing as well as drying. You can buy this at your drugstore (but it is a bit pricey) or you can make a similar solution by mixing 1 part vinegar to 4 parts water.  Apply this solution to the weepy/inflamed area several times a day. I soak cotton diapers or old t-shirts or burp pads and lay it over the area for awhile. There is another product called Zeasorb that absorbs moisture as well.

It sometimes also helps to use a topical cortisone cream to help with the inflammation. There are several products available OTC, or your doctor may also prescribe a steroid cream.

Because the top layer of the skin has been damaged it is also prone to getting an infection. If the area is not getting better and appears infected you should see your doctor as the skin may get secondarily infected with bacteria as well as yeast. In these cases I use a topical antibacterial cream or anti-fungal cream. In some cases an oral antibiotic may be necessary.

The best medicine is always prevention, so don't over bundle your baby and make sure to get in those "creases" so you don't end up having to treat intertrigo.