Miliaria

Published on 11/06/2015 by admin

Filed under Pediatrics

Last modified 22/04/2025

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Miliaria cristallina. Multiple 1–2-mm vesicles in sweat pores of a newborn.

Miliaria rubra. Tiny red papules on chest of infant.

CLINICAL FEATURES

In newborns and especially premature infants, obstruction of the outer one-third of the sweat duct presents as 1–2 mm discrete, clear vesicles without inflamed skin (miliaria cristallina). With cooling, the vesicles disappear in 24–48 hours leaving a tiny white scale.

It also occurs in older children in areas of sunburn. Infants may also develop miliaria rubra, characterized by tiny red papules or papulovesicles usually on flexural areas (neck, axillae, groin) and the trunk. This is due to deeper obstruction of the lower one-half of the sweat duct.

Both forms of miliaria are induced by heat retention on the skin or induced sweating, air-tight clothing or dressings. Immobilized children may develop miliaria from plastic bedcovers. Secondary infection with S. aureus may occur, producing pustules in the sweat pores (miliaria pustulosa). This is more prevalent in hot, humid conditions.

TREATMENT

Allowing the skin surface to dry and cool is the treatment of choice. Causes of overheating of the skin must be corrected. Cooling lotions will not be effective unless the overheating is corrected. Avoidance of overclothing the baby will be preventative.