How can a patient manage heat rash?

Managing Heat Rash

Heat rash (miliaria) is best managed by immediately removing heat exposure, keeping the affected skin cool and dry, and using gentle cleansing with pH-neutral soap substitutes followed by emollients, with topical hydrocortisone reserved for significant inflammation. 1, 2

Immediate Management: Remove Heat Exposure

• The single most critical intervention is eliminating the heat source and moving to a cooler environment 1, 3
• Remove or change out of perspiration-soaked clothing immediately, as moisture-trapped fabric perpetuates the condition 1
• In hot environments (temperatures above 39°C), regular clothing changes and maintaining dry skin are essential preventive measures 1
• Avoid direct heat sources including space heaters, heating pads, and prolonged sun exposure 4, 2

Skin Hygiene and Cleansing

• Wash affected areas with gentle, pH-neutral synthetic detergents or dispersible creams as soap substitutes, not regular soap which removes natural skin lipids and worsens irritation 2, 5
• Use tepid (not hot) water for cleansing 6, 5
• Pat skin dry gently with a soft, clean towel rather than rubbing 2, 7
• Maintain good hygiene standards with regular gentle cleansing to minimize infection risk, particularly important as heat rash can become superinfected with Staphylococcus aureus 1, 2

Topical Treatment Based on Location

Different body areas require different formulation approaches 2:

• For skin folds where rash remains moist: use drying pastes 2
• For seborrheic areas (scalp, face): use gels 2
• For areas outside skin folds: use creams 2
• Avoid greasy topical products as they inhibit moisture evaporation and promote superinfection 2, 6

Emollient Application

• Apply emollients after bathing to provide a surface lipid film that prevents transepidermal water loss 2, 5
• Use fragrance-free, hypoallergenic moisturizers 6
• Emollients are most effective when applied to damp skin immediately after cleansing 5

Anti-Inflammatory Treatment for Symptomatic Relief

• For significant erythema and inflammation, apply hydrocortisone 1% cream to affected areas 3-4 times daily 8
• Topical corticosteroids should be used for limited periods only (not exceeding 2-4 weeks), especially on the face, due to risks of skin atrophy and tachyphylaxis 2, 6
• Hydrocortisone is FDA-approved for temporary relief of itching associated with minor skin irritations, inflammation, and rashes 8

Managing Pruritus

• For moderate to severe itching, oral H1-antihistamines (cetirizine, loratadine, or fexofenadina) may provide relief 2, 6
• Urea- or polidocanol-containing lotions can soothe pruritus when applied topically 2
• Keep nails short to minimize skin damage from scratching 2, 6

Prevention and Avoidance Strategies

• Wear breathable cotton clothing rather than synthetic or wool fabrics that trap heat and moisture 2, 1
• Ensure thorough laundering of clothing to remove detergent residue, which can exacerbate skin irritation 1
• Avoid extremes of temperature and outdoor activities during the hottest periods of the day 2
• Use cooling measures: cold water spraying, cool showers, air conditioning, or fans in hot environments 2
• Avoid skin irritants including perfumes, deodorants, and alcohol-based lotions 2, 6

When to Seek Medical Attention

• Report to a healthcare provider immediately if signs of secondary bacterial infection develop: crusting, weeping, increased warmth, or purulent drainage 2, 1
• Miliaria with superimposed Staphylococcus infection can be serious and requires antibiotic treatment 1
• Heat rash typically clears within a week with appropriate management, but persistent cases may require medical evaluation 1

Common Pitfalls to Avoid

• Do not apply moisturizers or topical products immediately before heat exposure as they can create a bolus effect and worsen the condition 2, 6
• Avoid hot water for bathing, which increases skin temperature and exacerbates heat rash 5
• Do not use regular soaps that strip natural skin oils 2, 5
• Avoid scratching the affected area, which increases infection risk 2