What is the treatment for heat rash?

Heat Rash Treatment

The treatment for heat rash includes cooling the affected area, keeping it dry, and applying topical corticosteroids for symptomatic relief, with calamine lotion or cooling compresses as additional options for symptom management. 1

Understanding Heat Rash

Heat rash (miliaria rubra) occurs when sweat ducts become blocked and sweat is trapped under the skin. It typically appears as small red bumps or blisters that can be itchy or prickly, commonly in skin folds and areas where clothing causes friction.

Treatment Algorithm

First-Line Management:

1. Cool the affected area:

   • Move to a cooler, less humid environment
   • Use air conditioning or fans to reduce ambient temperature
   • Take cool showers or baths

2. Keep the skin dry:

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

3. Topical treatments:

   • Apply calamine lotion to soothe irritated skin
   • Use cooling compresses with cold water
   • For moderate to severe cases, apply low-potency topical corticosteroids (e.g., hydrocortisone 1-2.5%) to reduce inflammation and itching 1

Additional Measures:

• Avoid excessive use of creams or ointments that could further block pores
• Use fragrance-free, hypoallergenic moisturizers if the skin becomes dry
• Dust the affected area with cornstarch-based powder (not talcum powder) to keep it dry

Special Considerations

For Severe or Persistent Cases:

• If secondary bacterial infection is suspected (increased pain, swelling, warmth, or yellow discharge), bacterial cultures should be obtained and appropriate antibiotics administered 2
• Consider oral antihistamines for severe itching (e.g., cetirizine, loratadine, fexofenadine) 2

Prevention Strategies:

• Avoid excessive heat and humidity when possible
• Take regular cool showers during hot weather
• Change sweat-soaked clothing promptly 3
• Ensure thorough laundering of clothing to remove detergent residue that may irritate skin 3
• Use air conditioning or fans to reduce ambient temperature

Common Pitfalls to Avoid

• Overtreatment: Avoid using high-potency topical corticosteroids for prolonged periods, especially on the face or in children, as this can lead to skin atrophy 1
• Ignoring secondary infection: Heat rash with superimposed Staphylococcus infections can become serious if untreated 3
• Continued heat exposure: Failing to remove the underlying cause (heat and humidity) will prevent resolution
• Occlusive clothing: Tight, synthetic clothing can worsen the condition and delay healing

Heat rash typically resolves within 7-10 days with proper care and removal of the causative factors. If the rash persists beyond this timeframe or worsens despite appropriate treatment, further evaluation by a healthcare provider is warranted.