What are the guidelines for managing miliaria?

Management of Miliaria (Heat Rash)

The primary treatment for miliaria involves cooling the skin, reducing sweating, and preventing secondary infection through simple measures including removal from hot environments, keeping the skin cool and dry, and avoiding occlusive clothing or topical products. 1, 2

Types of Miliaria

• Miliaria crystallina: Presents as fragile, clear fluid-filled vesicles on the skin surface, caused by blockage of sweat ducts at the most superficial level 2
• Miliaria rubra (prickly heat): Appears as erythematous papules and vesicles with surrounding erythema, often pruritic and uncomfortable 3
• Miliaria profunda: Uncommon but potentially disabling condition characterized by deeper obstruction of sweat ducts 4
• Bullous miliaria: Rare presentation with larger bullae formation 1

First-Line Management

Immediate Interventions

• Remove patient from hot, humid environment when possible 2
• Keep affected areas cool, well-ventilated and dry to promote remission 2
• Avoid occlusive clothing and switch to loose-fitting, lightweight, breathable fabrics 3
• Ensure regular changing of clothing, especially when sweating occurs 3

Cooling Measures

• Apply cool compresses to affected areas 3
• Use air conditioning or fans to reduce ambient temperature and humidity 2
• Take cool showers or baths to reduce skin temperature 3

Preventive Measures

• Maintain good personal hygiene with regular bathing to remove sweat, salt, and debris 3
• Thoroughly launder clothing to remove all detergent residue, which can contribute to skin irritation 3
• Avoid applying occlusive topical products that may block sweat ducts 2

Second-Line Management

For Symptomatic Relief

• Topical calamine lotion or mild corticosteroids may help reduce inflammation and itching in miliaria rubra 3
• For miliaria profunda, anhydrous lanolin and isotretinoin have shown benefit in some cases 4

For Secondary Infection

• Monitor for signs of superimposed bacterial infection, particularly Staphylococcus 3
• Topical or systemic antibiotics may be necessary if secondary infection develops 3

Special Considerations

High-Risk Environments

• Individuals working in hot environments should take additional precautions including regular breaks in cooler areas 3
• Those required to wear flame-resistant or other occlusive clothing for occupational reasons should change clothing frequently and maintain meticulous skin hygiene 3

Medical Conditions

• Patients with persistent febrile states are at higher risk of developing miliaria 5
• Certain medications, including chemotherapeutic agents like idarubicin, may increase the risk of miliaria 5

Prognosis

• Miliaria is typically self-limiting and resolves within a week once the causative factors are addressed 3
• Complete recovery is expected with appropriate topical skin treatment and modifications to clothing and environment 3

When to Seek Medical Care

• If the rash persists despite cooling measures and improved ventilation 2
• If there are signs of secondary infection (increased pain, purulent discharge, spreading erythema) 3
• If the patient develops systemic symptoms such as fever not explained by other causes 3