Miliaria profunda results from ductal occlusion at the dermal-epidermis junction or papillary dermis. Papules are larger than miliaria rubra and are firm and skin colored. The miliaria profunda eruption can be pruritic or asymptomatic. It usually is shorter lived than a miliaria rubra eruption (lasting usually no more than 1 hour after overheating has ceased). The most common locations for miliaria profunda are the extremities and trunk. Due to the blockage of the eccrine ducts, there is associated anhidrosis or hypohidrosis. This can be accompanied by a compensatory hyperhidrosis in the face and axilla. Usually, the patient does not complain of any symptoms, but the hypohidrosis can potentially lead to heat exhaustion manifesting as dizziness, fatigue, and weakness.
There is no racial or sex predisposition, but children and young infants have a greater risk for developing the disease due to immature eccrine ducts. Miliaria profunda is often seen in soldiers working in tropical climates.
L74.2 – Miliaria profunda
47317002 – Miliaria profunda
Differential Diagnosis & Pitfalls
- Other miliaria variants, including miliaria crystallina, miliaria pustulosa, and miliaria rubra
- Fungal skin infections such as candidiasis can also present with pustules, but they are usually erythematous rather than skin colored.
- Viral infection such as varicella or herpes simplex – Differentiate the herpetic vesicles on an erythematous base with the skin-colored papules of miliaria profunda; miliaria profunda is most commonly asymptomatic, compared to herpetic pain and pruritus.
- Folliculitis – Miliaria profunda, in contrast, is not follicular.
- Acne is also worsened by skin occlusion but usually not as acutely as miliaria profunda.
- Arthropod bites
- Grover disease – Differentiate the red papules and papulovesicles from the white to skin-colored papules of miliaria profunda.
- Papular urticaria