MILIARIA

Definition

It is anhidrotic disorders in

which the sweat pore is

closed, resulting in retention

of sweat in the skin.

Based on clinical and
histopathologic findings, is
subdivided into four groups :

1. Miliaria crystallina
(sudamina), in which the
obstruction is within the
stratum corneum.
2. Miliaria rubra (prickly heat),
in which the block is a
deeper level within the
epidermis.
3. Miliaria pustulosa, some of
the eruption of miliaria rubra
that become pustular.
4. Miliaria profunda, in which

a still deeper obstruction

exists at the dermo-

epidermal junction.
 Epidemiology

• All infants develop miliaria

under appropriate conditions.
As these children grow older,
however, many lose this
susceptibility, only about
40% of adults retain the
tendency.
• Under chronic & extreme
tropical conditions adults
susceptible to miliaria
apparently increases to from
70 - 90%, well over the 40%
level of moderately hot
conditions.
• Prolonged exposure to a hot,

humid environment, such as

exist in the tropics & in

certain occupation, favors

the production of miliaria.

 Pathogenesis
• Miliaria plugging of
the eccrine duct, followed
ruptur of the duct & sweating
below the level obstruction
parakeratotic plug forms in
the duct, probably as a
result of injury to epidermal
cells lining the duct.
• Chemical & selective

electrical injury to the

ecrine pore.
Clinical Manifestation
DEFINITION
• Miliaria crystallina, is
characterized by minute
crystalline vesicles about 1
mm in diameter, on
uninflamed otherwise
normal-looking skin.
• Miliaria rubra, is the most
DEFINITION
important clinical form & is
the only type in which the
symptom of pruritus is
experienced.
The lesions are small
erythematous macules with a
punctata vesicle.
 DEFINITION
• Some of the eruptions of

miliaria rubra become

pustular, resulting in

Miliaria pustulosa.
 DEFINITION
• Miliaria profunda, the lesions
are whitish papules about 1 -
3 mm in diameter; they are
most prominent on the trunk
but may be seen on parts of
the extremities as well.
 Diagnosis

• Based on clinical
manifestation.

• There are no other

cutaneus or laboratory
procedures of diagnostic
value.
• A biopsy study will

establish beyond question

the nature of all forms of

miliaria.
Differential Diagnosis

• A primary irritancy

reaction.

• Erythema neonatorum.

• Folliculitis.
 Treatment

• Placing the patient in a

cool environment in which

sweating ceases.
• The keratinous plugs

occluding the sweat pores are

gradually shed over several

days, but some glands may

remain obstructed for 2 - 3

weeks.
• An air conditioner in the
sleeping area, generally
permitting at least 8 hours of
every day in a non sweating
state, is prophylactic,
apparently preventing the
early changes leading to
miliaria.
• Topical antibiotics also seem

to prevent miliaria

experimentally but do not

seem to be remarkably

effective clinically.
• Topical & systemic
corticosteroids have no
merit, in suggested use to
oral ascorbic acid in high
doses to prevent or
minimize miliaria.
 Prognosis

• Miliaria will not remit

spontaneously unless a

cool, non sweating

environment is provided.
• In a hot environment with
continued extended periods of
sweating, the miliaria will
become increasingly extensive,
eventually involving enough
glands to compromise the
temperatur - regulating
mechanism & lead to a heat
stress syndrome.
• In long-standing miliaria rubra,
the eventual development of
miliaria profunda is inevitable
& with in the incapacitating
picture of tropical anhidrotic
asthenia.