eMedicine Specialties > Dermatology > Diseases of the Adnexa

Miliaria: Follow-up

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

Follow-up

Deterrence/Prevention

  • Patients should avoid exposure to conditions of high heat and humidity.
  • When patients are in tropical climates, they should wear lightweight clothing, avoid exertion, use sunscreen, and stay in air-conditioned buildings as much as possible.
  • In patients with a history of miliaria, the application of topical anhydrous lanolin before exercise may help prevent the formation of new lesions.

Complications

  • The most common complications of miliaria are secondary infection and heat intolerance.
    • Secondary infection may appear as impetigo or as multiple discrete abscesses known as periporitis staphylogenes.
    • Heat intolerance is most likely to develop in patients with miliaria profunda; it is recognized by anhidrosis of the affected skin, weakness, fatigue, dizziness, and even collapse. In its most severe form, this heat intolerance is known as tropical anhidrotic asthenia.

Prognosis

  • Most patients recover uneventfully within a matter of weeks, once they move to a cooler environment.

Patient Education

  • Patients who have had miliaria, especially miliaria profunda, must be aware of the role of heat and humidity in precipitating this condition.
  • These patients should be advised to wear lightweight clothing, stay out of the sun, avoid exertion in hot weather, and stay in an air-conditioned environment as much as possible.

Miscellaneous

Special Concerns

  • 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.
 


More on Miliaria

Overview: Miliaria
Differential Diagnoses & Workup: Miliaria
Treatment & Medication: Miliaria
Follow-up: Miliaria
Multimedia: Miliaria
References
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References

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  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].

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  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].

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  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].

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  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].

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Further Reading

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Keywords

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

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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.

 
 
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