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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 – Usually affects the warm, moist areas, such as groin, axillae, and neck. The lesion consists of beefy red, moist erythema with satellite pustules. A KOH scraping from the pustules demonstrates pseudohyphae and spores.
• Scabies – Pruritic papules, papulovesicles, nodules, and linear burrows on the palms, soles, wrists, ankles, axillae, groin, and genitals. Unlike miliaria, often involves acral sites, especially the presence of burrows in the finger webs. Family history is often present.
• Varicella presents as vesicles on an erythematous base ("dewdrops on a rose petal") and are in different stages of development.
• Folliculitis – Has follicular-based pustules.
• Neonatal or infantile acne – Can also be worsened by occlusion but usually lacks pruritus and is less acute.
• Herpes simplex virus (HSV) infection – Characteristic grouped vesicles on an erythematous base.

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