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 and isotretinoin has resulted in dramatic improvement in patients with miliaria profunda. [25]
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.
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.
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Miliaria crystallina in an infant. Note that the lesions are confluent. Courtesy of K.E. Greer, MD.
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Miliaria rubra in an adult. Courtesy of K.E. Greer, MD.
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Miliaria pustulosa. Courtesy of K.E. Greer, MD.
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Miliaria crystallina. Note the water-drop appearance of the lesions. Courtesy of K.E. Greer, MD.
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Miliaria crystallina in a newborn child. Courtesy of K.E. Greer, MD.
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Miliaria pustulosa. Courtesy of K.E. Greer, MD.
