A visible patch of bright red irritation along the right side of President Donald Trump’s neck drew significant attention online after he appeared at the White House to deliver a statement on the war with Iran. The 79-year-old president’s skin condition sparked immediate speculation across social media, with theories ranging from contact dermatitis caused by dry-cleaning chemicals on his suit to rosacea, a condition he is already known to have. Some commenters went further, suggesting the possibility of shingles. The White House responded quickly, with his physician Dr. Sean Barbabella issuing a statement intended to put the speculation to rest.
“President Trump is applying a very common cream to the right side of his neck, which represents a preventive treatment prescribed by his physician,” Dr. Barbabella’s statement read. “The President has been using this treatment for a week and the redness is expected to last for a few weeks.” No specific diagnosis was confirmed in the statement, leaving dermatologists and commentators to interpret what the visible inflammation most likely represented.
The medical professionals who weighed in pointed most strongly toward actinic keratosis as the probable underlying condition. Also known as solar keratosis, these are dry, scaly patches of skin caused by years of sun exposure, appearing most often on the face, scalp, ears, neck, and the backs of the hands and forearms. Dr. Paul Farrant, a dermatologist and director at Experts in Skin and Hair, told the Daily Mail that the presentation was consistent with treatment for this condition. “Such a red and very inflamed rash on the right side of the neck could well be the result of treatment for actinic keratosis, a pre-cancerous skin condition caused by sun damage,” he said.
Actinic keratoses are extremely common among older adults, affecting roughly one in four people over the age of 60. The patches are typically between a third of an inch and just under an inch across, and can range in color from skin-toned to pink, red, or brown, often feeling rough to the touch. According to NHS guidelines, the condition itself is not usually serious, but a small percentage of untreated lesions can progress to squamous cell carcinoma, a form of skin cancer. When only a single spot is present, doctors may advise monitoring. Multiple spots, or those causing pain and itching, are generally treated more actively.
Treatment options include prescription creams, cryotherapy in which the lesion is frozen, or minor surgical procedures. Clinical immunologist Dr. Zachary Rubin speculated in a video on Facebook that the President may be using a cream called 5-fluorouracil, a topical chemotherapy agent. “One of the possible treatments is a topical cream called 5-FU, which can make the skin become very irritated and red, which could be consistent with what we are seeing here,” he said. Dr. Farrant, however, suggested a different candidate was more probable, pointing toward Tirbanibulinib, a similar medication typically applied for only five days, which he noted would align with the White House physician’s statement. Dr. Christopher Rowland-Payne of The London Clinic offered useful context on how these treatments work: “The stronger the inflammatory reaction to treatment, the better the outcome for the patient. We expect some redness when the cream is applied, and that’s not necessarily a bad sign.”
According to NHS guidance, the inflammatory reaction from these topical treatments can develop over up to 28 days, with the skin potentially becoming moist and crusted before gradually healing. A short course of topical steroid cream is sometimes prescribed afterward to calm the inflammation. While between five and ten percent of actinic keratoses progress to cancer, the condition is considered the starting point for most squamous cell carcinomas, making early detection and treatment the most effective approach to long-term skin health.
Consistent use of sunscreen with an SPF of at least 30 and avoiding outdoor exposure during peak UV hours are the most reliable preventive measures. Newer research also suggests that vitamin B3, known as niacinamide, may help reduce the risk of developing actinic keratoses over time.
Have you or anyone you know dealt with actinic keratosis? Share your experience in the comments.
