What is the treatment for heat rash (miliaria)?

Treatment for Heat Rash (Miliaria)

The treatment for heat rash (miliaria) should focus on cooling the affected area, keeping the skin dry, and removing any factors that cause excessive sweating. The primary interventions include moving to a cooler environment, removing excess clothing, and applying cooling measures to the affected skin 1.

First-line Treatment Approach

1. Cooling measures:

   • Move to a cooler, less humid environment
   • Remove excess clothing to allow skin to breathe
   • Take cool baths or showers
   • Apply cool compresses to affected areas

2. Keep skin dry:

   • Pat skin dry rather than rubbing
   • Avoid tight-fitting clothing
   • Wear lightweight, loose-fitting, cotton clothing
   • Avoid synthetic fabrics that trap heat

3. Topical treatments:

   • For mild cases: Keep skin clean and dry
   • For itching: Apply over-the-counter hydrocortisone cream (0.5-1%) up to 3-4 times daily 2
   • Avoid oil-based products or heavy lotions that may block pores

Treatment Based on Severity

Mild Heat Rash

• Cooling measures alone are usually sufficient
• Ensure good ventilation to affected areas
• Avoid activities that cause excessive sweating until resolved

Moderate to Severe Heat Rash

• Continue cooling measures
• Apply topical hydrocortisone 1% to reduce inflammation and itching 2
• Consider calamine lotion for symptomatic relief of itching
• If secondary bacterial infection is suspected (increased redness, pain, warmth, pus), consult a healthcare provider as antibiotics may be needed 3

Special Considerations

• For children under 2 years: Do not use over-the-counter hydrocortisone without consulting a doctor 2
• For persistent cases: If heat rash persists beyond 1 week despite treatment, medical evaluation is recommended 3
• For recurrent cases: Identify and address underlying causes such as occlusive clothing, excessive heat exposure, or occupational factors

Prevention Strategies

• Dress appropriately for hot weather in lightweight, loose-fitting clothing
• Use air conditioning or fans in hot environments
• Take regular cool showers during hot weather
• Change sweat-soaked clothing promptly
• Thoroughly launder clothing to remove detergent residue that may irritate skin 3
• Maintain good personal hygiene to keep skin clean and dry

Common Pitfalls to Avoid

• Using oil-based products that can block pores and worsen the condition
• Continuing to wear occlusive clothing that traps heat and moisture
• Scratching affected areas, which can lead to secondary infection
• Delaying treatment of severe or infected heat rash
• Returning to hot environments before the rash has completely resolved

Heat rash typically resolves within a few days with proper care and avoiding heat exposure. If symptoms worsen or don't improve with these measures, medical evaluation is recommended to rule out other skin conditions or complications.