Miliaria L74.3

Itchy skin rash with millet grain size ( Miliaria cristallina) or reddened papules(Miliaria rubra), often caused by heavy sweating. Pathogenetically, increased sweat secretion results in a dislocation of the sweat gland duct. Depending on the location of the occlusion, different forms are distinguished.

The infant's miliaria is subject to its own laws. Infant miliaria (rubra) is a frequent "disease" of the mature and premature infant beyond the first weeks of life after exposure to heat.

A distinction is made between:

• Miliaria cristallina (occlusion of the sweat gland ducts in the str. corneum. This results in the smallest water-clear vesicles).
• Miliariarubra (occlusion of the sweat gland ducts below the stratum granulosum; the sweat diffuses into the tissue and induces an inflammatory reaction)
• Miliariaprofunda (deep-seated occlusion of the sweat gland ducts with the formation of itchy nodules)
• Miliariapustulosa (with bacterial overgrowth)
• Miliaria of the infant (Miliaria of the infant is subject to its own regularity. It is a common "disease" of the mature and premature infant beyond the first weeks of life) .

Mainly occurring in the tropics. In temperate latitudes especially with close-fitting, final clothing.

Infant miliaria is a common disease of the newborn.

Because heat and sweat are the main risk factors for miliaria, general measures to reduce sweating and block eccrine ducts are warranted in the treatment of miliaria. These include cooler environments, wearing breathable clothing, exfoliating the skin, removing skin-occluding items such as bandages or plasters, and treating febrile illness. Miliaria crystallina is not usually treated because it is self-limiting and usually resolves within 24 hours. Miliaria rubra treatment aims to reduce inflammation, and therefore mild to moderate corticosteroids such as triamcinolone 0.1% cream, clobetasone butyrate cream may be used for one to two weeks. If miliaria pustulosa develops, topical antibiotics such as clindamycin are indicated to treat the overlying bacterial infection. Very little information is available on the treatment of miliaria profunda other than the general measures listed above. However, the results of one study showed improvement in Miliaria profunda with the combined use of oral isotretinoin 40 mg per day for 2 months and topical anhydrous lanolin.

In adults: For itching antihistamines such as desloratadine (e.g. Aerius) 5 mg/day p.o. or levocetirizine (e.g. Xusal) 5 mg/day p.o.

No internal therapy is necessary for infants.

1. Carter R et al (2011) Patients presenting with miliaria whilewearing
   flame resistant clothing in high ambient temperatures: a case series. JMed
   Case Rep 5: 474
2. Fölster-Holst R, Höger P (2004) Pustular skin diseases of the newborn. JDDG 2: 561-579
3. Haas N et al (2002) Congenital miliaria crystallina. J Am Acad Dermatol 47: 270-272
4. Wenk C et al (2003) Epidemiology of pediatric dermatology and allergology in the region of aargau, Switzerland. Pediatric Dermatol 20: 482-487