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Miliaria crystallina in Adult
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Miliaria crystallina in Adult

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Contributors: Noah Craft MD, PhD, Lindy P. Fox MD, Lowell A. Goldsmith MD, MPH
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Miliaria is caused by occlusion of the eccrine sweat ducts. There are various clinical patterns of miliaria depending on the level of occlusion.

Miliaria crystallina results from blockage of the eccrine sweat duct in the stratum corneum, corresponding to the formation of asymptomatic pinpoint, fragile vesicles. Miliaria crystallina is most common in neonates, but is seen in adults in the setting of bedridden patients with high fever and excessive sweating. The use of occlusive products prior to exercise may induce this as well. It is also more common in tropical climates.

Superficial occlusion is thought to result from increased hydration compounded with humidity and sweating. When the occlusion of the sweat duct is deeper in the epidermis, miliaria rubra (prickly heat), miliaria pustulosa, or miliaria profunda (skin-colored papules with possible associated hypohidrosis or anhidrosis) may result.


L74.1 – Miliaria crystallina

44279002 – Miliaria crystallina

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Varicella – Presents with vesicles on an erythematous base (eg, "dewdrops on a rose petal") and with lesions in different stages.
  • Folliculitis – Has follicular-based pustules.
  • Herpes simplex – Presents with painful crops of vesicles that often occur near a mucosal surface.
  • Acute generalized exanthematous pustulosis (AGEP) – Pustules are opaque, not clear as in miliaria.
  • Lesions may resemble toxic epidermal necrolysis with the presence of desquamation. However, miliaria crystallina does not have the intense erythema, mucosal involvement, or systemic illness associated with toxic epidermal necrolysis.
  • Vesicular drug eruption

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Management Pearls

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Updated: 04/29/2019
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Miliaria crystallina in Adult
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Miliaria crystallina : Fever, Developed rapidly in minutes or hours, Primarily truncal, Tiny vesicle
Clinical image of Miliaria crystallina
A close-up of myriads of tiny vesicles on the chest.
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