Best Lotion for Prickly Heat Rash
For prickly heat rash (miliaria), use cooling antipruritic lotions containing menthol (0.5-1%) in aqueous cream or emollient base as first-line topical therapy, avoiding alcohol-containing products. 1
Understanding Prickly Heat
Prickly heat (miliaria) occurs when sweat ducts become blocked, causing sweat retention beneath the skin surface. 2, 3 The condition is self-limited and typically resolves spontaneously within hours to days once the triggering factors are removed. 2
First-Line Topical Treatment
Apply menthol-containing lotions (0.5-1% menthol in aqueous cream) to affected areas as needed for symptomatic relief. 1, 4 These cooling preparations provide immediate soothing effects and are safe for frequent application. 1
- Calamine lotion is traditionally used but should be avoided as it has been shown to be ineffective for pruritic conditions. 1
- Emollients should be oil-in-water creams or ointments, not alcohol-containing lotions or gels which can worsen skin irritation. 1
Essential Environmental Modifications
The cornerstone of treatment is cooling the skin and avoiding further heat exposure. 2, 3
- Keep affected areas cool, well-ventilated, and dry. 3
- Avoid hot showers and excessive soap use. 1
- Remove occlusive clothing and reduce ambient temperature. 2
When Itching is Severe
If pruritus is bothersome despite cooling lotions:
- Add oral non-sedating antihistamines: loratadine 10 mg once daily or fexofenadine 180 mg once daily. 1, 5
- For nighttime itching disrupting sleep, consider diphenhydramine 25-50 mg at bedtime or hydroxyzine 25-50 mg at bedtime. 5
- Urea-containing or polidocanol-containing lotions can provide additional antipruritic effects. 1
Products to Avoid
- Do not use crotamiton cream—it is ineffective. 1
- Do not use topical capsaicin for miliaria. 1
- Avoid alcohol-based lotions or gels as they cause excessive drying. 1
Expected Timeline
Miliaria crystallina (the most superficial form with clear vesicles) typically resolves within hours once fever subsides and cooling measures are implemented. 2 Miliaria rubra (the red, itchy form) may persist for up to 21 days even with appropriate treatment. 6
When to Escalate Care
If the rash persists beyond 2-3 weeks despite environmental modifications and topical therapy, or if secondary bacterial infection develops (indicated by crusting, weeping, or pustules), seek medical evaluation for possible antibiotic therapy. 1