How do I treat prickly heat?

Treatment of Prickly Heat

To treat prickly heat (miliaria crystallina/rubra), move to a cool environment, apply cool compresses, keep the affected area clean and dry, and avoid activities that cause sweating until the rash resolves. 1

Understanding Prickly Heat

Prickly heat, also known as heat rash or miliaria, is a benign cutaneous manifestation caused by obstruction of sweat ducts following excessive exposure to heat, humidity, or hyperthermia. It presents as:

• Miliaria crystallina: Clear vesicular lesions on healthy skin (most superficial form)
• Miliaria rubra: Red, itchy papules and vesicles ("prickly heat")
• Miliaria profunda: Deeper, flesh-colored lesions

The condition occurs when sweat ducts become blocked, trapping sweat beneath the skin, typically in hot and humid environments 2.

Treatment Algorithm

Immediate Management

1. Move to a cooler environment - Remove the person from heat exposure 1
2. Cool the skin
   • Apply cool compresses to affected areas
   • Take a cool shower or bath with mild soap
   • Avoid using ointments or creams that can further block pores

Supportive Care

1. Keep affected areas dry

   • Pat skin dry rather than rubbing
   • Wear loose, lightweight, cotton clothing
   • Change wet clothing promptly

2. Reduce inflammation and discomfort

   • Apply calamine lotion to soothe itching
   • Use powder (cornstarch-based, not talcum) to keep the area dry
   • Avoid scratching to prevent secondary infection

Prevention of Recurrence

1. Avoid triggers

   • Stay in air-conditioned environments when possible during hot weather
   • Limit physical activity in hot, humid conditions
   • Wear breathable fabrics

2. Maintain skin hygiene

   • Shower promptly after sweating
   • Use antibacterial soap if recommended by healthcare provider
   • Change clothes frequently in hot weather

Special Considerations

When to Seek Medical Attention

• If the rash covers a large portion of the body
• If there are signs of infection (increasing redness, warmth, pain, pus)
• If accompanied by fever or other systemic symptoms
• If the rash doesn't improve within a few days with home treatment

Pitfalls to Avoid

1. Do not use heavy creams or ointments - These can further block sweat ducts and worsen the condition
2. Avoid tight clothing - This can trap heat and sweat against the skin
3. Do not scratch - This can lead to skin breaks and secondary infection
4. Avoid excessive heat exposure - This can worsen symptoms and delay healing

Recovery

Miliaria crystallina typically heals spontaneously within a few hours to days as the febrile syndrome resolves, often followed by mild desquamation 2. Most cases of prickly heat resolve completely with simple cooling measures and removal from the heat source.

For persistent or severe cases, consultation with a healthcare provider may be necessary to rule out other skin conditions or complications.