Dermatologic Manifestations of Miliaria Workup

  • Author: Nikki A Levin, MD, PhD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Mar 1, 2012
 

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).

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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.

In the granulomatous giant centrifugal variant of miliaria profunda, biopsies show mild spongiosis and acanthosis, hypergranulosis, and hyperplasia of the acrosyringia, the eccrine ducts, and infundibula, with invagination by keratin plugs. There is a granulomatous inflammatory infiltrate within the dermis, consisting of lymphocytes and foreign body giant cells with a few neutrophils centered around the ruptured straight portion of the eccrine duct.[13]

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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.

Specialty Editor Board

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 Dermatological Association, American Federation for Medical Research, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

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

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.

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: Lippincott Williams Wilkins Royalty Textbook editor; DLA Piper Consulting fee Consulting

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M 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, Ackerman Academy of Dermatopathology, New York

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

Disclosure: Nothing to disclose.

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. Ale I, Lachapelle JM, Maibach HI. Skin tolerability associated with transdermal drug delivery systems: an overview. Adv Ther. Oct 2009;26(10):920-35. [Medline].

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

  5. 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].

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

  7. 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].

  8. Huda M, Saha P. Pattern of dermatosis among pediatric patients attending a medical college hospital in northeastern region of India. Indian J Dermatol. 2009;49:189.

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

  10. 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].

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

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

  13. Doshi BR, Mahajan S, Kharkar V, Khopkar US. Granulomatous Variant of Giant Centrifugal Miliaria Profunda. Pediatr Dermatol. Jan 26 2012;[Medline].

  14. Carter R 3rd, Garcia AM, Souhan BE. Patients presenting with miliaria while wearing flame resistant clothing in high ambient temperatures: a case series. J Med Case Reports. 2011;5(1):474. [Medline].

  15. 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].

  16. 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].

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

  18. 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].

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

  20. 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].

  21. 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].

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

 
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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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