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Miliaria rubra in Child
Other Resources UpToDate PubMed

Miliaria rubra in Child

Contributors: Craig N. Burkhart MD, Dean Morrell MD, Susan Burgin MD
Other Resources UpToDate PubMed


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).

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).


L74.0 – Miliaria rubra

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.
  • 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.
  • Herpes simplex virus (HSV) infection – Characteristic grouped vesicles on an erythematous base.

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Last Reviewed:03/19/2017
Last Updated:04/28/2019
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Patient Information for Miliaria rubra in Child
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Contributors: Medical staff writer


Heat rash (miliaria rubra), also known as prickly heat, is a rash of small, red bumps caused by blockage of the sweat glands. It can be due to high fever, excessive sweating, or being over-bundled. Heat rash is commonly seen in hot, humid tropical climates. It can cause discomfort, itching, and, sometimes, stinging or "prickly"-type pain.

Who’s At Risk

Heat rash is seen in individuals who have a fever or those who have recently moved to a hot, humid climate. As many as 30% of those who move to a tropical environment experience this condition. Heat rash can be due to high fever, excessive sweating, or being over-bundled. It occurs in individuals of all races, although to a lesser degree in Asians.

Signs & Symptoms

Heat rash can occur after exposure to hot conditions. There can be many small, red bumps all over the body, usually occurring in highest concentration in covered areas where there is a lot of friction, such as the neck, chest, and body folds. The face, palms, and soles are generally not affected. Heat rash can cause intense itching and stinging, which can become worsened by heat. Your child may feel fatigued and become irritable and intolerant of heat, due to little or no sweating at the affected areas.

Self-Care Guidelines

Prevention and treatment of heat rash consist of controlling heat and humidity. Acetaminophen or ibuprofen can help to reduce fever. Remove any occlusive clothing, limit activity, and seek air conditioning or any cooler environment. Cool compresses can also help with the discomfort of heat rash. Make sure your child is drinking lots of fluids.

When to Seek Medical Care

The most common complications of heat rash include secondary infection from scratching and heat exhaustion.

Call your child's doctor if he/she is scratching significantly. There are medications that can help with the itching and, thus, help prevent infection. Infected areas may need antibiotics. Call your child's doctor if the area develops pus, redness, crusting, swelling, or tenderness.

In cases of heat exhaustion, the skin will appear hot and flushed without any sweat. Your child may complain of dizziness, nausea, weakness, headache, confusion, or difficulty breathing. This can progress to heat stroke, so medical care should be obtained right away. Symptoms of heat stroke include a very high temperature of 105°F or greater, decreased or loss of consciousness, or seizure.

While awaiting medical care, get your child indoors or under shade, undress the child, and apply cool compresses to the body or douse with cool water. Do not give fluids.


If there are signs of bacterial skin infection related to the heat rash or otherwise, oral or topical antibiotics may be given.

Dehydration may be treated with intravenous fluids, especially if there is vomiting. Heat stroke is treated by trying to quickly reduce the core temperature to normal. Immersion, evaporative, or invasive cooling techniques may be used in addition to rapidly giving intravenous fluids.


Bolognia, Jean L., ed. Dermatology, pp. 510, 578-579. New York: Mosby, 2003.

Wolff, Klaus, ed. Fitzpatrick's Dermatology in General Medicine. 7th ed., p. 730. New York: McGraw-Hill, 2008.
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Miliaria rubra in Child
A medical illustration showing key findings of Miliaria rubra : Fever, Rash, Developed rapidly , Pruritus
Clinical image of Miliaria rubra - imageId=2037503. Click to open in gallery.
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