II. Epidemiology
- Occurs in all ages, but more common children (and 40% of newborns) whose Sweat Glands are under-developed
III. Pathophysiology
- Sweat retention when Eccrine Glands (Sweat Glands) partially close or are obstructed by Stratum Corneum
- Provoked by excessive sweating
- Similar pathophysiology to Milia, but these two conditions are not the same
IV. Types: Common
- Miliaria Crystallina (Miliaria Alba, Miliaria Sudamina): Yellow Lesions
- Typically seen in newborns (up to 90%) in first week of life
- Sweat infiltrates below Stratum Corneum
- Vessicles 1-2 mm without surrounding erythema on head, neck and trunk
- Noninflammatory Vesicles resemble water droplets
- Each vessicle ruptures and then desquamates and resolves within days
- Miliaria Rubra (Heat Rash or Prickly Heat, default type of Miliaria): Red Lesions
- Most common form of Miliaria, occurring in children and adults who travel to warm environments
- Sweat infiltrates deeper, below Epidermis
- Inflammation associated with Sweat Gland obstruction
- Pruritic erythematous Papules and Vesicles on covered (over-heated) skin
V. Types: Other
- Apocrine Miliaria (Fox-Fordyce Disease)
- Miliaria Profunda
- Asymptomatic, flesh colored, small, deep Papules on the trunk and extremities
- Complication of severe Miliaria Rubra occurring in hot, humid climates
VI. Risk Factors
- Newborns (Miliaria Crystallina)
- Immature Sweat Glands
- Excessive sweating
- Acutely, on travel to hot, humid environments
- Intense Exercise
- Fever
- Occlusive clothing
- Hyperhidrosis
VII. Symptoms
- Very pruritic rash
VIII. Signs: Newborns with Miliaria Crystallina (Miliaria Alba, Miliaria Sudamina)
- Tiny (1-2 mm) superficial fragile Vesicles without inflammation
- Distributed over the head, neck and upper trunk
IX. Signs: Children and Adults with Miliaria Rubra
- Characteristics
- Initial: Intensely pruritic, small (2-4 mm) Vesicles and Papules on erythematous base
- Next week: Vesicles fill keratin and obstruct Sweat Glands
- Next: Obstructed Sweat Glands rupture and form deeper inflammation, and may persist for weeks
- Distribution
- Children: Neck, Axilla and groin
- Intertriginous areas and occluded areas
- Adults: Scalp, neck, upper trunk and extremity flexor surfaces
- Areas of friction (where clothes rubs against skin)
- Children: Neck, Axilla and groin
X. Differential Diagnosis: Newborns with Miliaria Crystallina (Miliaria Alba, Miliaria Sudamina)
XI. Differential Diagnosis: Children and Adults with Miliaria Rubra
XII. Management
- No treatment is typically needed (esp. in newborns with Miliaria Crystallina)
- In newborns, resolves spontaneously in first few months of life
- Individual lesions resolve in days
- Treat secondary infections (e.g. Impetigo)
- Stay in cooler environment with reduced sweating
- Change clothing to breathable, loosely fitting, clean, dry, cotton
- Avoid lotions (occlusive and may obstruct Sweat Glands)
- Avoid skin irritants and use only products free of perfume and dye
XIII. Prevention
- Avoid Occlusion and excessive heat
- Avoid over-dressing
- Consider cool baths (avoid prolonged exposure due to Hypothermia)
- Stay in cool air conditioned environments
XIV. Complications
- Chronic dermatitis
- May follow more severe Heat Rash
- Secondary Bacterial Skin Infection
- Superinfection, typically from scratching
XV. Resources
- DermNet NZ
XVI. References
- Claudius and Behar in Herbert (2020) EM:Rap 20(8): 5-7
- Salinas and Ruttan (2017) Crit Dec Emerg Med 31(9): 3-10
- Zink (2020) Crit Dec Emerg Med 34(3): 19-27
- Feng (1995) Cutis 55:213-6 [PubMed]
- O'Connor (2008) Am Fam Physician 77:47-52 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| 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 |
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 |
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 |
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 |
