eMedicine Specialties > Dermatology > Diseases of the Adnexa

Miliaria: Differential Diagnoses & Workup

Author: Nikki A Levin, MD, PhD, Associate Professor of Medicine, Division of Dermatology, University of Massachusetts Medical School
Contributor Information and Disclosures

Updated: Mar 11, 2009

Differential Diagnoses

Candidiasis, Cutaneous
Pityrosporum Folliculitis
Chickenpox
Pseudomonas Folliculitis
Erythema Toxicum Neonatorum
Folliculitis
Herpes Simplex

Other Problems to Be Considered

Infantile acne
Viral exanthem

Workup

Laboratory Studies

  • Miliaria is clinically distinctive; therefore, few laboratory tests are necessary.
  • In miliaria crystallina, cytologic examination of the vesicular contents fails to reveal inflammatory cells or multinucleated giant cells (as would be expected in herpes vesicles).
  • In miliaria pustulosa, cytologic examination of the pustular contents reveals inflammatory cells.
    • Unlike erythema toxicum neonatorum, eosinophils are not prominent.
    • Gram staining may reveal gram-positive cocci (eg, staphylococci).

Histologic Findings

In miliaria crystallina, intracorneal or subcorneal vesicles communicate with eccrine sweat ducts, without surrounding inflammatory cells. Obstruction of the eccrine duct may be observed in the stratum corneum.

In miliaria rubra, spongiosis and spongiotic vesicles are observed in the stratum malpighian, in association with eccrine sweat ducts. Periductal inflammation is present.

In early lesions in miliaria profunda, a predominantly lymphocytic periductal infiltrate is present in the papillary dermis and lower epidermis. A PAS-positive diastase-resistant eosinophilic cast may be seen in the ductal lumen. In later lesions, inflammatory cells may be present lower in the dermis, and lymphocytes may enter the eccrine duct. Spongiosis of the surrounding epidermis and parakeratotic hyperkeratosis of the acrosyringium may be observed.

More on Miliaria

Overview: Miliaria
Differential Diagnoses & Workup: Miliaria
Treatment & Medication: Miliaria
Follow-up: Miliaria
Multimedia: Miliaria
References
[ CLOSE WINDOW ]

References

  1. Champion RH. Disorders of sweat glands. In: Champion RH, Burton JL, Burns DA, Breathnach SM, eds. Textbook of Dermatology. 6th ed. Malden, Mass: Blackwell Scientific Publications; 1998:1997-9.

  2. Wenzel FG, Horn TD. Nonneoplastic disorders of the eccrine glands. J Am Acad Dermatol. Jan 1998;38(1):1-17; quiz 18-20. [Medline].

  3. Holzle E, Kligman AM. The pathogenesis of miliaria rubra. Role of the resident microflora. Br J Dermatol. Aug 1978;99(2):117-37. [Medline].

  4. Mowad CM, McGinley KJ, Foglia A, Leyden JJ. The role of extracellular polysaccharide substance produced by Staphylococcus epidermidis in miliaria. J Am Acad Dermatol. Nov 1995;33(5 Pt 1):729-33. [Medline].

  5. Hidano A, Purwoko R, Jitsukawa K. Statistical survey of skin changes in Japanese neonates. Pediatr Dermatol. Feb 1986;3(2):140-4. [Medline].

  6. Moosavi Z, Hosseini T. One-year survey of cutaneous lesions in 1000 consecutive Iranian newborns. Pediatr Dermatol. Jan-Feb 2006;23(1):61-3. [Medline].

  7. Kirk JF, Wilson BB, Chun W, Cooper PH. Miliaria profunda. J Am Acad Dermatol. Nov 1996;35(5 Pt 2):854-6. [Medline].

  8. Arpey CJ, Nagashima-Whalen LS, Chren MM, Zaim MT. Congenital miliaria crystallina: case report and literature review. Pediatr Dermatol. Sep 1992;9(3):283-7. [Medline].

  9. Straka BF, Cooper PH, Greer KE. Congenital miliaria crystallina. Cutis. Feb 1991;47(2):103-6. [Medline].

  10. Haas N, Henz BM, Weigel H. Congenital miliaria crystallina. J Am Acad Dermatol. Nov 2002;47(5 Suppl):S270-2. [Medline].

  11. Argoubi H, Fitchner C, Richard O, Lavocat MP, Cambazard F, Stephan JL. [Pustular miliaria rubra and systemic type 1b pseudohypoaldosteronism in a newborn]. Ann Dermatol Venereol. Mar 2007;134(3 Pt 1):253-6. [Medline].

  12. Urbatsch A, Paller AS. Pustular miliaria rubra: a specific cutaneous finding of type I pseudohypoaldosteronism. Pediatr Dermatol. Jul-Aug 2002;19(4):317-9. [Medline].

  13. Akcakus M, Koklu E, Poyrazoglu H, Kurtoglu S. Newborn with pseudohypoaldosteronism and miliaria rubra. Int J Dermatol. Dec 2006;45(12):1432-4. [Medline].

  14. Tabanelli M, Passarini B, Liguori R, Balestri R, Gaspari V, Giacomini F, et al. Erythematous papules on the parasternal region in a 76-year-old man. Clin Exp Dermatol. May 2008;33(3):369-70. [Medline].

  15. Haas N, Martens F, Henz BM. Miliaria crystallina in an intensive care setting. Clin Exp Dermatol. Jan 2004;29(1):32-4. [Medline].

  16. Gupta AK, Ellis CN, Madison KC, Voorhees JJ. Miliaria crystallina occurring in a patient treated with isotretinoin. Cutis. Oct 1986;38(4):275-6. [Medline].

  17. Godkar D, Razaq M, Fernandez G. Rare skin disorder complicating doxorubicin therapy: miliaria crystallina. Am J Ther. May-Jun 2005;12(3):275-6. [Medline].

  18. Shuster S. Duct disruption, a new explanation of miliaria. Acta Derm Venereol. Jan 1997;77(1):1-3. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

miliaria, heat rash, sudamina, miliaria crystallina, prickly heat, miliaria rubra, mamillaria, miliaria profunda, miliaria pustulosa, eccrine sweat glands, blockage of sweat ducts

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Nikki A Levin, MD, PhD, Associate Professor of Medicine, Division of Dermatology, University of Massachusetts Medical School
Nikki A Levin, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Phi Beta Kappa, and Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

Janet Fairley, MD, Professor and Head, Department of Dermatology, University of Iowa
Janet Fairley, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Federation for Medical Research, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Rosalie Elenitsas, MD, Herman Beerman Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System
Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.