Heat Rash Treatment in Infants
The primary treatment for heat rash (miliaria rubra) in infants is cooling measures—move the infant to a cooler environment, remove excess clothing layers, and allow the skin to air dry; the rash typically resolves spontaneously within days without medication. 1
Immediate Management: Environmental Cooling
The cornerstone of heat rash treatment is reducing heat exposure and allowing the skin to cool naturally:
- Remove the infant from hot environments immediately and place in a cooler, well-ventilated area 1
- Dress the infant appropriately for the environment—no more than one layer more than an adult would wear to be comfortable, as overbundling contributes to heat rash 2
- Evaluate for signs of overheating including sweating or the infant's chest feeling hot to the touch 2
- Allow open air exposure to affected areas when possible to facilitate cooling and drying 3
Skin Care Approach
Once cooling measures are initiated, gentle skin care supports resolution:
- Avoid applying oils or thick emollients during acute heat rash, as these can trap heat and worsen the condition 4
- Use water alone for cleansing affected areas—soaps and cleansers should be used infrequently and limited to diaper area, groin, and axillae 4, 5
- Pat skin dry gently rather than rubbing to avoid further irritation 4
- Keep skin folds clean and dry to prevent maceration, which can complicate heat rash 4
When Topical Medications May Be Considered
Most heat rash resolves with cooling alone, but persistent or severe cases may warrant additional intervention:
- Low-potency topical corticosteroids (such as hydrocortisone) can be applied 3-4 times daily for persistent symptomatic rash in children ≥2 years of age 6
- For infants under 2 years, consult a physician before using any topical corticosteroid 6
- Topical steroids should only be used for severe or persistent cases that don't respond to cooling measures alone 1, 3
Critical Pitfalls to Avoid
- Do not overbundle infants—this is the most common cause of heat rash and can increase SIDS risk through overheating 2
- Avoid covering the infant's face and head excessively, as this contributes to overheating 2
- Do not apply thick barrier creams or oils during active heat rash, as these trap heat 4
- Distinguish heat rash from other conditions—if the rash doesn't improve with cooling within 2-3 days, or if the infant appears systemically ill, evaluate for other causes including infection 1, 3