- Jami L Miller, MD
Jami L Miller, MD
- Assistant Professor of Medicine
- Vanderbilt University
Eccrine miliaria (miliaria) is a common, transient cutaneous disorder caused by blockage within the eccrine sweat duct. It is also known as "sweat rash," "prickly heat," or "heat rash." There are three main types of miliaria – crystallina, rubra, and profunda – which are distinguished by clinical appearance as well as histologic findings (picture 1A-D). The type of miliaria that develops depends upon the level at which the duct is blocked.
The clinical features, diagnosis, and management of miliaria will be reviewed here.
Miliaria occurs most commonly under conditions of sweating. It is found in both children and adults. All types are found in all races. Miliaria occurs in both sexes, though in some studies men were more commonly affected due to outdoor activities or occupations.
●Miliaria crystallina, also known as sudamina, is very common in neonates. Incidence peaks at approximately one week of age. Reports of frequency range from 4.5 percent  to 9 percent . It has also been reported in adults. Congenital miliaria crystallina has been described.
- Hidano A, Purwoko R, Jitsukawa K. Statistical survey of skin changes in Japanese neonates. Pediatr Dermatol 1986; 3:140.
- Goyal T, Varshney A, Bakshi SK. Incidence of Vesicobullous and Erosive Disorders of Neonates: Where and How Much to Worry? Indian J Pediatr 2011.
- LYONS RE, LEVINE R, AULD D. Miliaria rubra, a manifestation of staphylococcal disease. Arch Dermatol 1962; 86:282.
- SANDERSON PH, SLOPER JC. Skin disease in the British army in S. E. Asia. I. Influence of the environment on skin disease. Br J Dermatol 1953; 65:252.
- Haque MS, Hailu T, Pritchett E, et al. The oldest new finding in atopic dermatitis: subclinical miliaria as an origin. JAMA Dermatol 2013; 149:436.
- Nguyen TA, Ortega-Loayza AG, Stevens MP. Miliaria-rash after neutropenic fever and induction chemotherapy for acute myelogenous leukemia. An Bras Dermatol 2011; 86:S104.
- Carter R 3rd, Garcia AM, Souhan BE. Patients presenting with miliaria while wearing flame resistant clothing in high ambient temperatures: a case series. J Med Case Rep 2011; 5:474.
- Ale I, Lachapelle JM, Maibach HI. Skin tolerability associated with transdermal drug delivery systems: an overview. Adv Ther 2009; 26:920.
- Gupta AK, Ellis CN, Madison KC, Voorhees JJ. Miliaria crystallina occurring in a patient treated with isotretinoin. Cutis 1986; 38:275.
- Godkar D, Razaq M, Fernandez G. Rare skin disorder complicating doxorubicin therapy: miliaria crystallina. Am J Ther 2005; 12:275.
- Haas N, Martens F, Henz BM. Miliaria crystallina in an intensive care setting. Clin Exp Dermatol 2004; 29:32.
- Hung C, Hsiao Y, Cheng J. Sudden blistering in the remission stage of Stevens–Johnson syndrome/toxic epidermal necrolysis overlap syndrome. J Am Acad Dermatol 2015; 72(5 Suppl 1):AB122.
- Chao CT. Hypernatremia-related miliaria crystallina. Clin Exp Nephrol 2014; 18:831.
- Urbatsch A, Paller AS. Pustular miliaria rubra: a specific cutaneous finding of type I pseudohypoaldosteronism. Pediatr Dermatol 2002; 19:317.
- Shuster S. Duct disruption, a new explanation of miliaria. Acta Derm Venereol 1997; 77:1.
- Kossard S, Commens CA. Keratotic miliaria precipitated by radiotherapy. Arch Dermatol 1988; 124:855.
- Hölzle E, Kligman AM. The pathogenesis of miliaria rubra. Role of the resident microflora. Br J Dermatol 1978; 99:117.
- Mowad CM, McGinley KJ, Foglia A, Leyden JJ. The role of extracellular polysaccharide substance produced by Staphylococcus epidermidis in miliaria. J Am Acad Dermatol 1995; 33:729.
- Donoghue AM, Sinclair MJ. Miliaria rubra of the lower limbs in underground miners. Occup Med (Lond) 2000; 50:430.
- Abou-Zeid E, Boursoulian LJ, Metzer WS, Gundogdu B. Morvan syndrome: a case report and review of the literature. J Clin Neuromuscul Dis 2012; 13:214.
- Hanukoglu I, Boggula VR, Vaknine H, et al. Expression of epithelial sodium channel (ENaC) and CFTR in the human epidermis and epidermal appendages. Histochem Cell Biol 2017; 147:733.
- Dixit S, Jain A, Datar S, Khurana VK. Congenital miliaria crystallina - A diagnostic dilemma. Med J Armed Forces India 2012; 68:386.
- Al-Hilo MM, Al-Saedy SJ, Alwan AI. Atypical presentation of miliaria in Iraqi patients attending Al-Kindy Teaching Hospital in Baghdad: A clinical descriptive study. Am J Dermatol Venereol 2012; 1:41.
- LUBOWE II, PERLMAN HH. Periporitis staphylogenes and other complications of miliaria in infants and children. AMA Arch Derm Syphilol 1954; 69:543.
- Doshi BR, Mahajan S, Kharkar V, Khopkar US. Granulomatous variant of giant centrifugal miliaria profunda. Pediatr Dermatol 2013; 30:e48.
- Sulzberger MB, Griffin TB. Induced miliaria, postmiliarial hypohidrosis, and some potential sequelae. Arch Dermatol 1969; 99:145.
- Tey HL, Tay EY, Cao T. In vivo imaging of miliaria profunda using high-definition optical coherence tomography: diagnosis, pathogenesis, and treatment. JAMA Dermatol 2015; 151:346.
- Moulonguet I, Ghnassia M, Molina T, Fraitag S. Miliarial-type perifollicular B-cell pseudolymphoma (lymphocytoma cutis): a misleading eruption in two women. J Cutan Pathol 2012; 39:1016.
- Kirk JF, Wilson BB, Chun W, Cooper PH. Miliaria profunda. J Am Acad Dermatol 1996; 35:854.