Search
miliaria rubra (prickly heat)
Etiology:
1) caused occlusion of sweat glands in the mid to lower layers of the epidermis
2) NaCl from dried sweat & thermal injury have been implicated in the pathogenesis
3) greasy topical agents & clothing may also block sweat glands
Epidemiology:
- very common in hot, humid areas & may also occur in hot, dry areas if pores are blocked by clothing
Clinical manifestations:
1) erythematous papulovesicular rash
2) stinging, pruritic lesions, pinhead size
3) distribution:
a) face
b) neck
c) upper trunk
d) clothed areas
e) sparing palms & soles
3) symptoms worse with onset of sweating
Differential diagnosis:
1) folliculitis: miliaria rubra is distinguished by its non-follicular distribution
2) papular urticaria: more erythematous than miliaria rubra
3) erythema toxicum: more erythematous than miliaria rubra
Laboratory: not useful in diagnosis of miliaria.
Management:
1) common to all forms of miliaria
a) moving to cooler environment
b) application of cool compresses
c) wearing light, loose-fitting clothing
d) avoidance of greasy topical agents
e) natural desquamation
f) ensure adequate hydration
2) The stinging of miliria rubra may be relieved by anhydrous lanolin or calamine lotion
General
miliaria (heat rash, sweat rash)
References
- Saunders Manual of Medical Practice, Rakel (ed),
WB Saunders, Philadelphia, 1996, pg 926
- Medical Knowledge Self Assessment Program (MKSAP) 16
American College of Physicians, Philadelphia 2012