Miliaria rubra, also known as heat rash or prickly heat, consists of erythematous papules caused by blockage of the eccrine sweat duct. The pathogenesis 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. Resident bacteria (Staphylococcus spp.) on the skin may also play a role. 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, as well as those involving deeper occlusion, miliaria pustulosa and miliaria profunda (skin-colored papules with possible associated hypohidrosis or anhidrosis).
Miliaria rubra in Adult
Alerts and Notices
Synopsis
Codes
ICD10CM:
L74.0 – Miliaria rubra
SNOMEDCT:
72658003 – Miliaria rubra
L74.0 – Miliaria rubra
SNOMEDCT:
72658003 – Miliaria rubra
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Miliaria rubra is often mistaken for a drug eruption, especially after a new antibiotic is started in a febrile patient.
- Other miliaria variants – Miliaria crystallina, miliaria pustulosa, miliaria profunda.
- Candidiasis – Often has some pustules.
- Scabies – Unlike miliaria, often involves acral sites; check for the presence of burrows in the finger webs.
- Varicella – Presents as vesicles on an erythematous base ("dewdrops on a rose petal"), and lesions are in different stages of development.
- 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.
- Grover disease – Also flares on the back of hospitalized patients with resulting very pruritic papules and erosions.
Best Tests
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Management Pearls
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Therapy
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References
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Last Reviewed:03/19/2017
Last Updated:04/28/2019
Last Updated:04/28/2019
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Miliaria rubra in Adult