What is wrong with Trump’s neck? Doctors reveal ‘likely’ cause of painful-looking rash that the White House say required ‘preventative treatment’

There has been mounting speculation since President Trump appeared at the White House this week with a vivid red rash along the right side of his neck.

The irritation was visible as he delivered an update on the war against Iran, prompting online debate about his health and what treatment he might be undergoing.

In response, the 79-year-old’s physician, Dr Sean Barbabella, issued a statement: ‘President Trump is using a very common cream on the right side of his neck, which is a preventative treatment, prescribed by the White House Doctor.

‘The President is using this treatment for one week and the redness is expected to last for a few weeks.’

While no diagnosis has been confirmed, commentators on social media have floated several possibilities – including contact dermatitis caused by dry cleaning chemicals used on his suits, and rosacea – a skin condition Trump has been confirmed to suffer, which causes flushing and redness.

Others suggested the crusty appearance could indicate shingles, a very painful rash of blisters caused by the chickenpox virus.

However skin specialists have said they believe the most likely explanation is actinic keratosis, a common sun-related skin condition that can, in some cases, develop into cancer.

Dr Paul Farrant, a consultant dermatologist and director at Experts in Skin and Hair said: ‘This kind of red very angry rash on the right side of his neck could definitely be caused by the treatment for actinic keratosis, a precancerous skin condition caused by sun damage.

‘When these creams are applied we would definitely expect long lasting redness and irritation, which looks like what’s going on underneath Trump’s collar.’ 

So what exactly is it – and what could it mean for the President’s health?

Actinic keratoses – also known as solar keratoses – are dry, scaly patches of skin caused by years of sun exposure. They tend to appear on areas frequently exposed to sunlight, such as the face, scalp, ears, neck, backs of the hands and forearms.

And it is incredibly common. Actinic keratosis affects around a quarter of people aged 60 and older.

Patches are usually between half an inch and an inch in size. They may be skin-coloured, pink, red or brown depending on skin tone, and often feel rough or gritty to the touch.

According to the NHS, the condition is not usually serious. However, there is a small risk that patches can develop into squamous cell carcinoma, a type of skin cancer that begins in the top layer of the skin.

If someone has only one patch, a GP may advise monitoring it to see whether it settles naturally. But if there are multiple patches, or if they are painful or itchy, treatment is typically recommended and referral to a dermatologist may follow.

Treatment options include prescription creams and gels, cryotherapy – where the lesion is frozen so it blisters and falls away – and minor surgical removal.

Clinical immunologist, Dr Zachary Rubin, has speculated that the President may be using 5-fluorouracil cream, a topical chemotherapy treatment commonly prescribed for widespread sun damage.

‘One of the potential treatments that can be used is a topical cream called 5-F.U which can cause the skin to look very irritated and red, potentially like what we see here,’ he said in a video posted to Facebook. 

But, Dr Farrant said it is more likely to be Tirbanibulin, which is a similar treatment typically used for just five days, which would ‘tally with the statement issued by the White House.’ 

The cream works by destroying abnormal, sun-damaged cells while largely sparing healthy skin. It is usually applied once daily for five days during which time the treated area becomes red, inflamed and sore – a reaction that indicates the medication is working.

Dr Christopher Rowland-Payne, a consultant dermatologist at The London Clinic, added: ‘The more inflammatory the response to treatment, the more beneficial the result to the patient. When cream is applied, we would expect some redness – and that’s not necessarily a bad thing.’ 

The NHS notes that depending on skin type, this inflammatory response can take up to 28 days to fully develop. During treatment, the skin may ooze, crust and scab before gradually healing over several weeks.

A short course of steroid cream is sometimes prescribed afterwards to reduce inflammation.

The British Association of Dermatologists says temporary skin discolouration can occur but usually fades with time. Less common side effects include prolonged inflammation, delayed healing and, in rare cases, ulceration – particularly on the lower legs.

While only around five to 10 per cent of actinic keratoses progress to cancer, the majority of squamous cell carcinomas – the most common form of skin cancer – begin as these sun-damaged patches.

Risk increases with the number of lesions present. People taking immunosuppressive medication are also at higher risk of malignant transformation.

Warning signs that a lesion may be turning cancerous include rapid growth, thickening into a lump, bleeding or increasing tenderness. Anyone noticing these changes is advised to seek medical review promptly.

More than 25,000 people in the UK are diagnosed with squamous cell carcinoma each year. In the US, the figure exceeds one million annually. When detected early, the cancer is highly treatable, but advanced cases can spread to other parts of the body.

The most effective way to prevent actinic keratoses is consistent sun protection – including daily use of sunscreen with an SPF of at least 30, reapplication during prolonged exposure, avoiding sunbeds and limiting time outdoors between 11am and 3pm when UV radiation is strongest.

The NHS also advises checking the skin regularly for new or changing patches.

There is emerging evidence that vitamin B3 – also known as nicotinamide – may reduce the risk of developing actinic keratoses and some skin cancers in high-risk individuals.

President Trump has repeatedly said he is in ‘perfect health’, which he attributes to ‘good genetics’.

For now, his doctor’s statement offers reassurance that the visible redness is a temporary reaction to treatment. But the episode has also shone a spotlight on a common condition that affects millions – and serves as a reminder of the long-term impact of sun exposure.