Miliaria rubra, also known as prickly heat or heat rash, is the most common form of miliaria. Miliaria rubra is due to the obstruction of the intraepidermal eccrine sweat ducts. The resultant sweat retention and the escape of sweat into the dermis evokes an inflammatory response that manifests as papules. The predisposing factors are hot and humid conditions, febrile illnesses, and occlusive clothing, dressing, or ointments (eg, Aquaphor).
Miliaria rubra has been reported to occur in newborns with type 1 pseudohypoaldosteronism. This typically resolves upon stabilization of disease.
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 Infant/Neonate
Alerts and Notices
Synopsis
Codes
ICD10CM:
L74.0 – Miliaria rubra
SNOMEDCT:
72658003 – Miliaria rubra
L74.0 – Miliaria rubra
SNOMEDCT:
72658003 – Miliaria rubra
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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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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 Infant/Neonate