All forms of miliaria are due to occlusion or disruption of the eccrine sweat ducts at various levels of the skin due to excessive sweating in hot or humid environments.
Miliaria crystallina consists of nonfolliculocentric, asymptomatic, fragile, clear vesicles that rupture easily with prompt self-resolution.
Miliaria rubra consists of nonfolliculocentric, erythematous papulovesicles with associated pruritus.
Miliaria profunda consists of nonfolliculocentric, pruritic flesh-colored papules as a result of multiple bouts of miliaria rubra. This form of miliaria is often associated with anhidrosis of the affected skin and can result in heat exhaustion.
The main treatment of choice for all forms of miliaria is placement of the patient in a cool environment.
Miliaria crystallina in hospitalized febrile patient
From Brian L. Swick's collection, used with permission
- nonfollicular vesicles and papules (all types)
- asymptomatic eruption (crystallina)
- clear noninflammatory vesicles (crystallina)
- fragile vesicles (crystallina)
- paroxysmal pruritus and stinging (rubra)
- erythematous papulovesicles (rubra)
- anhidrosis (profunda)
- compensatory hyperhidrosis (profunda)
- flesh-colored papules (profunda)
- desquamative healing (crystallina)
- weakness and malaise (profunda)
- dyspnea (profunda)
- tachycardia (profunda)
- hyperpyrexia (profunda)
Other Tests to Consider
- Tzanck smear
- viral direct fluorescent antibody (DFA) or culture
- viral PCR
- bacterial culture
- fungal culture
- KOH prep
- skin biopsy
- cool environment plus supportive care
- antibacterial agents
- febrile patients
- with pruritus
- antipruritic agents
- with miliaria profunda