The neck is an interesting area of highly mobile skin that provides a transition between the thin skin of the neck and the thicker skin of the upper chest and back. It contains fully mature hairs in the male and thin vellus hairs in the female. It is an important area from a cosmetic standpoint since it is an area affected by shaving in the male, fragrance application in the female, and photodamage in both sexes.
Anatomy and Physiology
The neck skin covers important underlying structures, such as the blood and nerve supply to the head. The neck also contains the cervical spine and numerous muscles allowing the head to move side to side. It is for this reason that the neck is a difficult area cosmetically. It does not heal well from cosmetic surgical or traumatic injuries due to this continuous movement. It is also is subject to photodamage, since many forget to wear protective clothing or apply sunscreen to the neck. Most hats do not provide adequate neck protection, thus the neck skin tends to show age more quickly than other body areas.
Common Dermatologic Disease Considerations
The photodamage condition that most commonly affects the neck is known as poikiloderma. Poikiloderma describes the thinned skin present from lost dermal collagen. It resembles chicken skin because the lower dermal oil glands become more visible as little tiny yellow dots. The thinned skin also allows better visualization of the underlying small vessel network creating the “red neck” terminology, used to describe those who work out of doors, such as cowboys. Lastly, poikiloderma describes the irregular pigmentation that results from prolonged photodamage characterized by both lighter and darker areas in almost a lace-like pattern. It is interesting to note that the neck skin beneath the chin is sun protected. For this reason, neck photodamage is almost in the shape of a butterfly being more pronounced on the sides of the neck. The degree of photodamage present on the skin of an individual can be easily determined by comparing the sun protected skin beneath the chin with the appearance of the sun damaged skin on the sides of the neck.
The neck is also the site where women apply fragrance. For this reason, the neck is a common site of fragrance allergy. This allergy can manifest as allergic contact dermatitis, which presents as red skin with little tiny bumps, known as papules, and blisters, known as vesicles. Patch testing fragrances is usually performed to determine the exact cause after treatment with topical corticosteroids. Fragrances can also cause irritant contact dermatitis, which presents as simply red, itchy skin, due to the drying volatile vehicle in the perfume.
Hygiene Needs
The hygiene needs of the neck are similar to the rest of the body. The neck does not contain many oil glands and thus cleansing should be thorough, but not over drying. Probably the most unique hygiene need for the neck area is in males who shave the hair in this location. The neck is a transition area for hair growth between the beard of the face and the body hair of the chest. For this reason, the hair exits the skin in many different directions, which predisposes to inflammation of the hair follicular ostia, more commonly known as razor burn. Severe razor burn accompanied by ingrown hairs in African-American males is known as pseudofolliculitis barbae. In this condition, the curved hair shafts re-enter the skin causing inflammation and infection. It is a difficult condition to treat. Growing a beard
and not shaving obtain the best results, since the long hairs cannot ingrow. The second best option to shave frequently and keep the hairs so short that they cannot ingrow.
Skin Care Needs
The major skin care needs of the neck are good moisturization accompanied by sun protection. The neck receives almost as much sun as the face and is a common site for precancerous and cancerous growths.