Miliaria

Source: http://en.wikipedia.org/wiki/Miliaria
Updated: 2017-06-25T08:37Z

For the bird, see Corn bunting.

"Prickly Heat" redirects here. For the UK game show, see Prickly Heat (game
show).
Miliaria (/ml.ir.i./; also called "sweat rash",[1] "heat rash" or "prickly
heat") is a skin disease marked by small and itchy rashes. Miliaria is a
common ailment in hot and humid conditions, such as in the tropics and
during the summer season. Although it affects people of all ages, it is
especially common in children and infants due to their underdeveloped sweat
glands.

Typical red spots on chest, neck and shoulders, caused by miliaria rubra

Signs and symptoms

Symptoms of miliaria include small red rashes, called papules, which are
irritated and itchy. These may simultaneously occur at a number of areas on a
sufferer's body, the most common including the upper chest, neck, elbow
creases, under the breasts and under the scrotum.[2] Other areas include skin
folds, areas of the body that may rub against clothing, such as the back,
chest, and stomach, etc. A related and sometimes simultaneous condition
is folliculitis, where hair follicles become plugged with foreign matter, resulting
in inflammation.
The symptoms relating to miliaria should not be confused with shingles as
they can be very similar. Shingles will restrict itself to one side of the body but
also has a rash-like appearance. It is also accompanied by a prickling
sensation and pain throughout the region. Those who suspect they have
shingles and not miliaria should seek medical advice immediately as the
sooner antivirals are taken, the better.

Types
Miliaria can be classified according to the top level at which obstruction occurs
in the sweat glands.
Miliaria crystalline
The most superficial obstruction (with the most mild clinical presentation), is
known as miliaria crystalline; instead of a rash, the patient presents with
multiple tiny blister-like lesions that look like beads of perspiration and
essentially cause no symptoms.[3]:23[4] Miliaria crystalline is also known as
"Miliaria crystallina,"[5] and "Sudamina". The superficial vesicles are not
associated with an inflammatory reaction.[3] :23
Miliaria rubra
The most commonly encountered form of the illness is miliaria rubra, in which
obstruction causes leakage of sweat into the deeper layers of the epidermis,
provoking a local inflammatory reaction and giving rise to the typical
appearance of redness (hence rubra) and larger (but still only a few
millimetres), blister-like lesions. This form of the illness is often accompanied
by the typical symptomsintense itching or "pins and needles" with a lack of
sweating (anhidrosis) to affected areas.[3]:23 There is a small risk of heat
exhaustiondue to inability to sweat if the rash affects a large proportion of the
body's surface area or the sufferer continues to engage in heat-producing
activity. Miliaria rubra is also known as prickly heat and heat
rash.[5] Differential diagnosis should be used to rule out polycythemia vera,
which is a rare hematological disorder and appears more often in males than
females, generally not before the age of 40. Both disorders share the common
denominator of appearing after taking a hot shower.[citation needed]
Miliaria profunda
The most severe form of miliaria, miliaria profunda, sometimes referred to as
"wildfire" due to the rapid spread and severe burning sensations, generally
occurs as a complication of repeated episodes of miliaria rubra. The
obstruction is located deep in the structure of the sweat gland, causing the
gland's secretions to leak between the superficial and deep layers of the skin.
The rash, and associated symptoms, tend to appear within hours of an activity
provoking sweating but similarly fade within hours when the stimulus for the
sweating is removed. Miliaria profunda is characterised by non-pruritic, flesh-
colored, deep-seated, whitish papules.[3]:24 The rash tends to be flesh-coloured
as opposed to the prominent redness of miliaria rubra, and the risk of heat
exhaustion is larger. Miliaria profunda is also less-commonly known as
"Mammillaria"[5]:chapter 40 [6]
Miliaria pustulosa
Miliaria pustulosa describes pustules due to inflammation and bacterial
infection.[7] Miliaria pustulosa is preceded by another dermatitis that has
produced injury, destruction, or blocking of the sweat duct.[3]:23
Postmiliarial hypohidrosis
Postmiliarial hypohidrosis is a skin condition that results from occlusion of
sweat ducts and pores, and may be severe enough to impair an individual's
ability to perform sustained work in a hot environment.[3]:24
Tropical anhidrotic asthenia
Tropical anhidrotic asthenia is a skin condition, a rare form of miliaria, with
long-lasting poral occlusion, which produces anhidrosis and heat
retention.[3]:24[5]
Occlusion miliaria
Occlusion miliaria is a skin condition that is accompanied by anhidrosis and
increased heat-stress susceptibility, all after the application of extensive
polyethylene film occlusion for 48 hours or longer.[3]:24
Colloid milium
Colloid milium is a skin condition characterized by a translucent, flesh-colored,
or slightly yellow 1- to 5-mm papule.[3]:31
Pathophysiology
Miliaria occurs when the sweat gland ducts get plugged due to dead skin cells
or bacteria such as Staphylococcus epidermidis,[8] a common bacterium that
occurs on the skin which is also associated with acne.
The trapped sweat leads to irritation (prickling), itching and to a rash of very
small blisters, usually in a localized area of the skin.

Prevention
Prickly heat can be prevented by avoiding activities that induce sweating,
using air conditioning to cool the environment,[9] wearing light clothing and in
general, avoiding hot and humid weather. Frequent cool showers or cool
baths with mild soap can help to prevent heat rash.

Treatment
The primary remedy for miliaria is to wear lighter clothing, move to a cooler
climate, or otherwise avoid overheating one's body. The immediate treatment
of the involved skin areas involves the use of a soothing ointment such as
calamine lotion.
Medical assistance should be sought for the first episode of a rash with the
appearance of miliaria. The differential diagnosis includes several conditions
that an experienced practitioner should be able to recognise and may require
treatment distinct from the usual measures taken for miliaria. In most cases
the rash of miliaria will resolve without intervention. However, severe cases
can last for weeks and cause significant disability. General measures should
be recommended for all patients, including moving to an air-conditioned
environment if possible, avoiding sweat-provoking activities and occlusive
clothing, and taking frequent cool showers.
It has been suggested that the use of topical antibacterials (including
antibacterial soaps) may shorten the duration of symptoms in miliaria rubra
even in the absence of obvious superinfection. Other topical agents that may
reduce the severity of symptoms include anti-itch preparations such
as calamine or menthol- or camphor-based preparations, and topical steroid
creams. However, caution should be used with oil-based preparations
(ointments and oily creams as opposed to water-based or aqueous lotions)
that may increase blockage to the sweat glands and prolong duration of
illness. Other agents have been investigated including supplemental vitamin A
and C and vitamin A based medications, but it is worth noting that there is little
scientific evidence supporting any of the above treatments in reducing the
duration of symptoms or frequency of complications.
In most cases, doctors will recommend that any pimple-like blisters that may
form should have the fluid drained out of them (either through in-
office procedure or at home in a sterile environment) to avoid the rash from
spreading underneath the skin, leading to an increased state of dermatitis.
Left untreated, the blisters may spread and take on an increased red
appearance, with the fluid inside increasing in viscosity. It is recommended by
physicians to sanitize the infected area and then drain the blisters with a
sterilized needleor lancet.
In most tropical areas the local dispensaries sell prickly heat powder, a talc
admixture containing drying milk proteins (Labilin) and Triclosan to fight the
infection. These include cooling menthol to help alleviate difficulty getting to
sleep. This is an effective treatmentthe powder stays on the skin longer and
treats bacteria dispersed into bed linens, providing a reasonably dry refuge
area for healing. Miliaria often covers large areas, and generous use of
Cortisone may be contraindicated for reasons stated on package warnings.
Regular talcum powder will not reduce the rash but can alleviate burning and
itching.
In cases where the rash has developed into open blisters or pustular lesions a
doctor should be consulted since more aggressive, medically monitored
treatment may be required.

References
1. ^ Miliaria (sweat rash). DermNet NZ
2. ^ Jacklitsch, Brenda L. (June 29, 2011). "Summer Heat Can Be Deadly for
Outdoor Workers". NIOSH: Workplace Safety and Health. Medscape and
NIOSH.
3. ^ a b c d e f g h i James, William D.; Berger, Timothy G. (2006). Andrews'
Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-
2921-0.
4. ^ Haas N, Martens F, Henz BM (2004). "Miliaria crystallina in an intensive
care setting". Clin. Exp. Dermatol. 29 (1): 32
34. PMID 14723716. doi:10.1111/j.1365-2230.2004.01444.x.
5. ^ a b c d Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L.
(2007). Dermatology: 2-Volume Set. St. Louis: Mosby. p. 541. ISBN 1-4160-
2999-0.
6. ^ G.O. Horne, F.R.C.P.E. and R.H. Mole, M.A., B.M., M.R.C.P., Trans R
Soc Trop Med Hyg (1951) 44 (4): 465-471. doi: 10.1016/S0035-
9203(51)80023-3
7. ^ "Miliaria".
8. ^ Mowad CM, McGinley KJ, Foglia A, Leyden JJ (1995). "The role of
extracellular polysaccharide substance produced by Staphylococcus
epidermidis in miliaria". J. Am. Acad. Dermatol. 33 (5 Pt 1): 729
733. PMID 7593770. doi:10.1016/0190-9622(95)91809-4.
9. ^ Niparko, John Kim; Klag, Michael J.; Lawrence, Robert M.; Romaine-Davis,
Ada (1999). Johns Hopkins family health book. London: HarperCollins.
p. 1308. ISBN 0-06-270149-5.