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Dermatologic Manifestations of Miliaria Differential Diagnoses

  • Author: Nikki A Levin, MD, PhD; Chief Editor: Dirk M Elston, MD  more...
Updated: Feb 09, 2016

Diagnostic Considerations

Miliaria crystallina and miliaria rubra are common in infants; therefore, pediatricians must be able to distinguish these conditions from other common eruptions that affect infants.

Miliaria crystallina can be confused with congenital herpes simplex, varicella, syphilis, candidiasis, or staphylococcal scalded skin syndrome. Cytologic findings in the blister fluid should rule out these conditions; cytologic methods may involve Tzanck preparation, Gram staining, and potassium hydroxide preparation, as well as the acquisition of a biopsy sample for histopathologic analysis.

Miliaria rubra can be confused with erythema toxicum neonatorum, infantile acne, or folliculitis. Pustules of erythema toxicum are characteristically filled with eosinophils, unlike those of miliaria rubra. Infantile acne typically involves the face in a follicular distribution. Miliaria may involve the face, as well as the trunk and axillae. Superficial folliculitis, as its name suggests, is follicular, unlike miliaria.

Differential Diagnoses

Contributor Information and Disclosures

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, Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD Herman Beerman 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, American Medical Association, American Society of Dermatopathology, Pennsylvania Academy of Dermatology

Disclosure: Received royalty from Lippincott Williams Wilkins for textbook editor.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Janet Fairley, MD Professor and Head, Department of Dermatology, University of Iowa, Roy J and Lucille A Carver College of Medicine

Janet Fairley, MD is a member of the following medical societies: American Academy of Dermatology, American Federation for Medical Research, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

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Miliaria crystallina in an infant. Note that the lesions are confluent. Courtesy of K.E. Greer, MD.
Miliaria rubra in an adult. Courtesy of K.E. Greer, MD.
Miliaria pustulosa. Courtesy of K.E. Greer, MD.
Miliaria crystallina. Note the water-drop appearance of the lesions. Courtesy of K.E. Greer, MD.
Miliaria crystallina in a newborn child. Courtesy of K.E. Greer, MD.
Miliaria pustulosa. Courtesy of K.E. Greer, MD.
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