DR K TAMILSELVAN

Miliaria

Miliaria, also known as prickly heat, heat rash, or sweat rash, is a skin condition that occurs when sweat ducts become blocked, trapping sweat in the skin. Miliaria 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.

Miliaria Rubra

Miliaria is a cutaneous condition with retention of sweat due to obstructions of sweat ducts, rupture of occluded ducts, and extravasation of sweat at different levels in the skin.

Causes of Miliaria 

Sweating is the most common risk factor, making hot or humid conditions and high fevers particularly associated with the development of miliaria.

Other causes of miliaria include

Occlusion of the skin

    Transdermal drug patches and tight clothing have been associated with miliaria.

Type I pseudo hypoaldosteronism

     This condition involves mineralocorticoid resistance, leading to sodium loss through eccrine glands, and has been associated with pustular miliaria rubra.

Strenuous physical activity

      Intense exercise can contribute to the development of miliaria.

Morvan’s syndrome syndrome

      A rare autosomal recessive disorder characterized by hyperhidrosis, among other abnormalities, which predisposes individuals to miliaria.

Medications

       Drugs that induce sweating, such as bethanechol, clonidine, and neostigmine, have been associated with miliaria. Additionally, a few cases of isotretinoin-induced miliaria have been reported

Classification of Miliaria   

      Miliaria rubra (Prickly heat)

      Miliaria – crystalline (Sudamina)

              Sweat is retained sub corneally, causing clear, drop like vesicles that rupture with light pressure

      Miliaria profunda

               Sweat is retained in the dermis, causing papules that are larger and more deeply seated than those of miliaria rubra

      Miliaria pustulosa

      Post miliarial hypo hidrosis

      Tropical anhidrotic asthenia

      Occlusion miliaria

      Colloid milium

Signs and symptoms of Miliaria   

Small red rashes, called as papules, which may itch or more often cause an intense ‘pins-and-needles’ prickling sensation. These may simultaneously occur at a number of areas on a sufferer’s body, the most common including the face, neck, under the breasts and under the scrotum. Other areas include skin folds, areas of the body that may rub against clothing, such as the back, chest, and stomach, etc.

Treatment for Miliaria

As hot and sweaty conditions are primary risk factors for miliaria, managing the condition involves implementing general measures to reduce sweating and prevent eccrine duct blockage. This includes creating cooler environments, wearing breathable clothing, exfoliating the skin, removing skin-occluding objects such as bandages or patches, and addressing febrile illnesses.

Specific modalities for the treatment of miliaria are unique depending on the type. Miliaria crystallina usually does not require treatment, as it is self-limiting and typically resolves within 24 hours. Miliaria rubra is managed by reducing inflammation; thus, mild-to-mid-potency corticosteroids, such as 0.1% triamcinolone cream, may be applied to the affected areas for 1 to 2 weeks. If miliaria pustulosa develops, topical antibiotics such as clindamycin are used to address the superimposed bacterial infection.

Limited information exists on the treatment of miliaria profunda beyond the general measures previously mentioned. However, studies have indicated that miliaria profunda may improve with a combined regimen of oral isotretinoin (40 mg/d for 2 months) and topical anhydrous lanolin

Complications of Miliaria   

       1.Secondary bacterial infection Miliaria pustulosa or frank impetigo (tropical impetigo)

       2.Anhidrotic asthenia if anhidrosis due to widespread Miliaria profunda

Prevention of  Miliaria

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