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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.

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