eMedicine Specialties > Dermatology > Diseases of the Adnexa

Miliaria: Treatment & Medication

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

Treatment

Medical Care

  • No compelling reason to treat miliaria crystallina exists because this condition is asymptomatic and self-limited.
  • Miliaria rubra can cause great discomfort, and miliaria profunda may lead to heat exhaustion. Treatment of these conditions is warranted.
  • The prevention and treatment of miliaria primarily consists of controlling heat and humidity so that sweating is not stimulated. Measures may involve treating a febrile illness; removing occlusive clothing; limiting activity; providing air conditioning; or, as a last resort, having the patient move to a cooler climate.
  • Topical treatments that have been advocated involve lotions containing calamine, boric acid, or menthol; cool wet-to-dry compresses; frequent showering with soap (although some discourage excessive use of soap); topical corticosteroids; and topical antibiotics.
  • The topical application of anhydrous lanolin has resulted in dramatic improvement in patients with miliaria profunda.7
  • The prophylaxis of miliaria with oral antibiotics is reported. Patients have also been treated with oral retinoids, vitamin A, and vitamin C, with variable success. To our knowledge, no controlled trials have been conducted to demonstrate the effectiveness of any of these systemic therapies.
  • Antimicrobial agents are effective in suppressing experimentally induced miliaria.

Activity

  • Because increased exertion leads to sweating, which greatly exacerbates miliaria, patients should be advised to limit their activity, especially in hot weather, until the miliaria resolves.
  • Patients with miliaria profunda are at particularly high risk for heat exhaustion during exertion in hot weather, because their ability to dissipate heat by means of evaporation of sweat is impaired.

Medication

The goal of treating miliaria rubra and miliaria profunda is to provide symptomatic relief and prevent hyperpyrexia and heat exhaustion. The authors know of no strong evidence indicating efficacy with systemic medications; therefore, topical medications are preferred.

Topical therapies

Anhydrous lanolin is believed to prevent ductal blockage, allowing sweat to flow to the skin surface. Calamine lotion provides cooling symptomatic relief after miliaria develops.


Lanolin anhydrous

Thought to prevent ductal blockage, allowing sweat to flow to the skin surface.

Adult

Apply topically to affected areas before exercise in hot weather

Pediatric

Apply as in adults

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

For external use only


Calamine lotion (Caladryl)

Provides cooling symptomatic relief after miliaria develops.

Adult

Apply to affected skin qd/bid

Pediatric

Apply as in adults

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

For external use only

More on Miliaria

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

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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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