Miliaria pustulosa in Adult
The pathogenesis of miliaria is often related to conditions of high fever or high ambient temperatures with resulting hyperhidrosis, and it is more prevalent in hot, humid conditions and tropical climates. It is a benign disease characterized by intense pruritus and a stinging or "prickly"-type sensation. It is a common phenomenon postoperatively and in bedridden and febrile patients.
Other miliaria variants include the most superficial type, miliaria crystallina, miliaria rubra itself, and miliaria profunda (skin-colored papules with possible associated hypohidrosis or anhidrosis).
Both miliaria rubra and pustulosa have been reported to occur in newborns with type 1 pseudohypoaldosteronism. This typically resolves upon stabilization of disease.
L74.3 – Miliaria, unspecified
26988005 – Miliaria pustulosa
Differential Diagnosis & Pitfalls
- Other miliaria variants (miliaria crystallina, miliaria rubra, miliaria profunda)
- Candidiasis – Often has some pustules.
- Folliculitis – Has follicular-based pustules.
- Acne – Can also be worsened by occlusion but usually lacks pruritus and is less acute.
- Acute generalized exanthematous pustulosis (AGEP) – Is more diffuse with widespread pustules.
- Varicella – Occasionally pustules are seen.
- Grover disease – Also flares on the back of hospitalized patients with resulting very pruritic papules and erosions. Pustules are not a feature.