Miliaria

Aka: Miliaria, Miliaria Rubra, Miliaria Alba, Miliaria Sudamina, Apocrine Miliaria, Miliaria Crystallina, Miliaria Profunda, Heat Rash, Sweat Rash, Lichen Tropicus, Prickly Heat, Fox-Fordyce Disease

II. Epidemiology

  1. Occurs in all ages, but more common children (and 40% of newborns) whose Sweat Glands are under-developed

III. Pathophysiology

  1. Sweat retention when Eccrine Glands (Sweat Glands) partially close or are obstructed by Stratum Corneum
  2. Provoked by excessive sweating
  3. Similar pathophysiology to Milia, but these two conditions are not the same

IV. Types: Common

  1. Miliaria Crystallina (Miliaria Alba, Miliaria Sudamina): Yellow Lesions
    1. Typically seen in newborns (up to 90%) in first week of life
    2. Sweat infiltrates below Stratum Corneum
    3. Vessicles 1-2 mm without surrounding erythema on head, neck and trunk
      1. Noninflammatory Vesicles resemble water droplets
      2. Each vessicle ruptures and then desquamates and resolves within days
  2. Miliaria Rubra (Heat Rash or Prickly Heat, default type of Miliaria): Red Lesions
    1. Most common form of Miliaria, occurring in children and adults who travel to warm environments
    2. Sweat infiltrates deeper, below Epidermis
      1. Inflammation associated with Sweat Gland obstruction
    3. Pruritic erythematous Papules and Vesicles on covered (over-heated) skin

V. Types: Other

  1. Apocrine Miliaria (Fox-Fordyce Disease)
  2. Miliaria Profunda
    1. Asymptomatic, flesh colored, small, deep Papules on the trunk and extremities
    2. Complication of severe Miliaria Rubra occurring in hot, humid climates

VI. Risk Factors

  1. Newborns (Miliaria Crystallina)
    1. Immature Sweat Glands
  2. Excessive sweating
    1. Acutely, on travel to hot, humid environments
    2. Intense Exercise
    3. Fever
    4. Occlusive clothing
    5. Hyperhidrosis

VII. Symptoms

  1. Very pruritic rash

VIII. Signs: Newborns with Miliaria Crystallina (Miliaria Alba, Miliaria Sudamina)

  1. Tiny (1-2 mm) superficial fragile Vesicles without inflammation
  2. Distributed over the head, neck and upper trunk

IX. Signs: Children and Adults with Miliaria Rubra

  1. Characteristics
    1. Initial: Intensely pruritic, small (2-4 mm) Vesicles and Papules on erythematous base
    2. Next week: Vesicles fill keratin and obstruct Sweat Glands
    3. Next: Obstructed Sweat Glands rupture and form deeper inflammation, and may persist for weeks
  2. Distribution
    1. Children: Neck, Axilla and groin
      1. Intertriginous areas and occluded areas
    2. Adults: Scalp, neck, upper trunk and extremity flexor surfaces
      1. Areas of friction (where clothes rubs against skin)

X. Differential Diagnosis: Newborns with Miliaria Crystallina (Miliaria Alba, Miliaria Sudamina)

  1. See Neonatal Pustules and Vessicles
  2. Erythema Toxicum Neonatorum
  3. Neonatal HSV
  4. Acne Neonatorum

XI. Differential Diagnosis: Children and Adults with Miliaria Rubra

  1. Viral Exanthem
  2. Varicella Zoster Virus
  3. Herpes Simplex Virus
  4. Superficial Folliculitis
  5. Acne Vulgaris
  6. Stevens-Johnson Syndrome (or Toxic Epidermal Necrolysis)

XII. Management

  1. No treatment is typically needed (esp. in newborns with Miliaria Crystallina)
    1. In newborns, resolves spontaneously in first few months of life
    2. Individual lesions resolve in days
    3. Treat secondary infections (e.g. Impetigo)
  2. Stay in cooler environment with reduced sweating
  3. Change clothing to breathable, loosely fitting, clean, dry, cotton
  4. Avoid lotions (occlusive and may obstruct Sweat Glands)
  5. Avoid skin irritants and use only products free of perfume and dye

XIII. Prevention

  1. Avoid Occlusion and excessive heat
  2. Avoid over-dressing
  3. Consider cool baths (avoid prolonged exposure due to Hypothermia)
  4. Stay in cool air conditioned environments

XIV. Complications

  1. Chronic dermatitis
    1. May follow more severe Heat Rash
  2. Secondary Bacterial Skin Infection
    1. Superinfection, typically from scratching

XV. Resources

  1. DermNet NZ
    1. https://dermnetnz.org/topics/miliaria/

XVI. References

  1. Claudius and Behar in Herbert (2020) EM:Rap 20(8): 5-7
  2. Salinas and Ruttan (2017) Crit Dec Emerg Med 31(9): 3-10
  3. Zink (2020) Crit Dec Emerg Med 34(3): 19-27
  4. Feng (1995) Cutis 55:213-6 [PubMed]
  5. O'Connor (2008) Am Fam Physician 77:47-52 [PubMed]

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Related Studies

Ontology: Fox Fordyce disease (C0016632)

Definition (MSH) Chronic pruritic disease, usually in women, characterized by small follicular papular eruptions in APOCRINE GLANDS areas. It is caused by obstruction and rupture of intraepidermal apocrine ducts.
Definition (NCI) A chronic inflammatory skin disorder characterized by pruritic papular eruptions in areas with apocrine glands. It usually affects the axillae bilaterally. There is rupture of the apocrine ducts resulting in inflammation and formation of the papular skin lesions.
Concepts Disease or Syndrome (T047)
MSH D005588
ICD9 705.82
ICD10 L75.2
SnomedCT 254682006, 65038009
English Fox Fordyce Disease, Fox-Fordyce Disease, Disease, Fox-Fordyce, Miliaria, Apocrine, Apocrine Miliaria, FOX FORDYCE DIS, Fox-Fordyce disease (diagnosis), Fox-fordyce disease, Fox-Fordyce Disease [Disease/Finding], Syndrome, Fox-Fordyce, Fox-Fordyce Syndrome, Fox Fordyce Syndrome, fordyce disease fox, fox-fordyce disease, apocrine miliaria, fox fordyce disease, miliaria apocrine, Fox Fordyce disease (disorder), Apocrine miliaria, Fox-Fordyce disease, Chronic itching papular eruption of axillae AND/OR pubes, Fox-Fordyce disease (disorder), Fox, Fordyce-Fox, miliaria; apocrine, apocrine; miliaria, Chronic itching papular eruption of axillae and pubes, Fox Fordyce disease
Italian Miliaria apocrina, Malattia di Fox-Fordyce
Dutch ziekte van Fox-Fordyce, apocrien; miliaria, miliaria; apocrien, Apocriene miliaria, apocriene miliaria, Apocriene milaria, Fox-Fordyce-ziekte, Milaria, apocriene, Ziekte, Fox-Fordyce-
French Maladie de Fox-Fordyce, Miliaire apocrine, Fox Fordyce, maladie
Japanese フォックス・フォアダイス病, ｱﾎﾟｸﾘﾝｶﾝｼﾝ, ﾌｫｯｸｽﾌｫｱﾀﾞｲｽﾋﾞｮｳ, フォックス･フォアダイス病, Fox-Fordyce病, フォックス･フォーダイス病, アポクリン汗疹, フォックス-オーアダイス病, フォックス-フォーダイス病, 汗疹-アポクリン
Swedish Fox-Fordyces sjukdom
Czech Foxova-Fordyceova nemoc, Apokrinní potničky, Fox-Fordyceova nemoc
Finnish Fox-Fordycen tauti
Russian FOKSA-FORDAISA BOLEZN', ФОКСА-ФОРДАЙСА БОЛЕЗНЬ
German Apokrine Miliaria, apokrine Miliaria, Fox-Fordyce-Krankheit, Milaria, apokrine
Korean 아포크린 땀띠
Croatian FOX-FORDYCEOVA BOLEST, MILIARIA APOCRINIS
Polish Choroba Foxa-Fordyce'a
Hungarian Fox-Fordyca állapot, Apocrin miliaria
Norwegian Fox-Fordyces sykdom, Apokrin miliaria
Spanish enfermedad de Fox - Fordyce (trastorno), enfermedad de Fox - Fordyce, erupción papulosa pruriginosa crónica de axila Y/O pubis, erupción papulosa pruriginosa crónica de axila y pubis, miliaria apocrina, Miliaria apocrina, Enfermedad de Fox-Fordyce, Miliaria Apocrina
Portuguese Miliária apócrina, Doença de Fox-Fordyce, Miliária Apócrina
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Miliaria (C0026113)

Definition (NCI) A small (one mm or less) vesicular, papular or pustular monomorphous rash, which is associated with heat, fever or occlusion of sweat glands.(NICHD)
Definition (MSH) A syndrome of cutaneous changes associated with sweat retention and extravasation of sweat at different levels in the skin. Miliaria rubra, or prickly heat, results from apocrine duct obstruction. The sweat then seeps into the epidermis, producing pruritic erythematous papulovesicles. (From Dorland, 27th ed)
Concepts Disease or Syndrome (T047)
MSH D008883
ICD10 L74.3
SnomedCT 201411009, 201196009, 63951004
English Miliaria, MILIARIA, Miliaria, unspecified, [X]Miliaria, unspecified, miliaria, miliaria (diagnosis), Miliaria [Disease/Finding], heat rash, sweat rash, [X]Miliaria, unspecified (disorder), Heat Rash, Prickly Heat, Miliaria (disorder), Miliaria, NOS
French MILIAIRE, Miliaire
Portuguese MILIARIA, Miliária, Brotoeja
Spanish MILIARIA, [X]miliaria, no especificada (trastorno), (X)erupción miliar, no especificada, [X]miliaria, no especificada, miliaria (trastorno), miliaria, Miliaria
German MILIARIA, Miliaria, nicht naeher bezeichnet, Miliaria, Dermatitis hidrotica, Hidroa, Sudamen
Swedish Miliaria
Czech miliaria, potničky, sudamina, Potničky
Finnish Miliaria
Russian POTNITSA, POTNITSA KRASNAIA, ПОТНИЦА, ПОТНИЦА КРАСНАЯ
Japanese 紅色汗疹, 粟粒疹, あせも, 汗疹, ｶﾝｼﾝ
Korean 상세불명의 땀띠
Croatian Not Translated[Miliaria]
Polish Potówki
Dutch miliaria, Miliaria, niet gespecificeerd, Miliaria
Hungarian Miliaria
Norwegian Varmeutslett, Miliaria
Italian Miliaria
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Miliaria Rubra (C0162423)

Concepts Disease or Syndrome (T047)
MSH D008883
ICD9 705.1
ICD10 L74.0 , L74.2
SnomedCT 44279002, 201197000, 156415007, 201190003, 267813002, 201194007, 72658003
English Prickly Heat, HEAT RASH, Heat, Prickly, Prickly heat NOS, Sweat rash, Miliaria Rubra, heat rash (diagnosis), heat rash, prickly heat, miliaria rubra, Rash;heat, sweat rash, Miliaria rubra (disorder), Prickly heat - miliaria, (Heat rash) or (sudamina) or (sweat rash) or (prickly heat - miliaria) (disorder), Prickly heat NOS (disorder), (Heat rash) or (sudamina) or (sweat rash) or (prickly heat - miliaria), Miliaria rubra, Prickly heat, Heat rash, Miliaria tropicalis, Prickly heat (disorder), heat; rash, miliaria; rubra, miliaria; tropicalis, rash; heat, rubra; miliaria, tropicalis; miliaria
Czech miliaria rubra, Potničky, Hluboké potničky, Potničky červené
Portuguese Miliária Rubra, ERUPCAO PELO CALOR, Erupção pelo calor, Calor com picadas, Miliária rubra
Spanish Miliaria Rubra, ERUPCION POR CALOR, salpullido por calor, SAI (trastorno), salpullido por calor, SAI, Miliaria rubra, Eritema por calor, Fiebre miliar, miliaria rubra (trastorno), miliaria rubra, miliaria tropical, rash por calor, salpullido por calor, sarpullido por calor
French Miliaire rouge, CHALEUR CUTANEE, Eruption sudorale, Démangeaison à la chaleur, Miliaria rubra, Miliaria Rubra, Éruption sudorale
German Miliaria rubra, HITZEAUSSCHLAG, Schweissflechte, Hitzeausschlag, Lichen tropicus
Korean 홍색 땀띠
Italian Miliaria Rubra, Sudamina, Miliaria rubra, Eruzione da calore, Miliaria
Dutch miliaria rubra, stekende hitte, hitterash, hitte; uitslag, miliaria; rubra, miliaria; tropicalis, rubra; miliaria, tropicalis; miliaria, uitslag; hitte, Miliaria rubra
Hungarian Hőkiütés, Hő-exanthema, Miliaria rubra
Japanese ｺｳｼｮｸｶﾝｼﾝ, 紅色汗疹
Norwegian Miliaria rubra
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Miliaria profunda (C0263468)

Concepts Disease or Syndrome (T047)
ICD10 L74.2
SnomedCT 201193001, 47317002
English miliaria profunda (diagnosis), miliaria profunda, Miliaria profunda, Miliaria profunda (disorder), miliaria; profunda, profunda; miliaria
Korean 심재성 땀띠
Czech Potničky hluboké
Dutch miliaria profunda, miliaria; profunda, profunda; miliaria, Miliaria profunda
French Miliaire profonde
German Miliaria profunda
Hungarian Miliaria profunda
Italian Miliaria profonda
Japanese 深在性汗疹, ｼﾝｻﾞｲｾｲｶﾝｼﾝ
Portuguese Miliária profunda
Spanish Miliaria profunda, miliaria profunda (trastorno), miliaria profunda
Derived from the NIH UMLS (Unified Medical Language System)

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