Miliaria is a rash in the form of transparent bubbles or red nodules, which occurs due to blockage of sweat glands and is most often caused by overheating of the body. According to the nature of the rashes, red, crystalline and papular miliaria are distinguished. The diagnosis usually does not cause difficulties, consultation with a dermatologist may be required only in complicated cases. The treatment is mainly to eliminate the factors that cause overheating and increased miliaria of the body. Measures to prevent include optimal room temperature, adequate weather clothing, personal hygiene and proper skin care.
Despite the fact that miliaria is considered mainly a childhood disease, adults are also susceptible to it. But most often miliaria occurs in children of the first year of life. This is due to the immaturity of the sweat glands and the thermoregulation mechanisms of infants. In both children and adults, poorly ventilated areas of the skin are more susceptible to miliaria rashes. These include skin folds (axillary, interstitial, inguinal, folds on the neck, between the fingers, under the mammary glands and behind the ears), elbow and knee bends, skin areas under tightly fitting synthetic fabrics (low-quality diapers, bandages, clothing made of synthetic “non-breathing” fabrics).
Normally, the human miliaria system is actively involved in the process of thermoregulation of the body. When the ambient temperature increases, the work of sweat glands is activated, they begin to intensively secrete sweat, which contributes to some cooling of the skin and protects the body from overheating. The same mechanism is triggered when the temperature of the body itself increases. For example, with various diseases occurring with fever (ARI, influenza, acute bronchitis, pneumonia, sore throat, measles, chickenpox, rubella, etc.), intense physical activity, thermal procedures, the use of warming compresses or wraps.
Intense form can lead to blockage of the sweat glands and the appearance of miliaria. Especially often, disease occurs in newborns and children under one year old, because their sweat glands are not fully formed and have narrow excretory ducts. Among adults, disease is more common in people with excessive miliaria, overweight or disorders of the endocrine system.
Depending on the type of rash, clinical dermatology distinguishes three clinical variants of miliaria: crystalline, red and papular.
Crystalline miliaria is represented by pearlescent or white bubbles with a diameter of 1-2 mm. Bubbles, merging with each other, can form larger bubbles. Within a few hours or days, they burst and dry out with the formation of flaky areas on the skin. This type of miliaria occurs mainly in newborn children and is located on the face, upper torso and neck. If crystalline miliaria occurs in an adult, it is usually localized on the skin of the chest, back and flexor surfaces of the legs and arms.
Red miliaria has the appearance of red nodules 1-3 mm in size and bubbles containing a cloudy liquid. These elements are surrounded by an inflammatory hyperemic corolla. As a rule, they do not merge with each other. Patients with red miliaria are concerned about severe itching, which increases with an increase in air temperature. Usually this type of miliaria affects the skin in places where it is exposed to friction. These are inguinal folds, axillary areas, flexor folds on the extremities and the skin under the mammary glands in women. It is red miliaria that most often occurs in adults in hot weather or with heavy physical labor.
Papular miliaria is characterized by rashes in the form of flesh-colored bubbles no larger than 3 mm in size. There are rashes on the skin of the trunk, arms and legs. Papular miliaria is usually found in tropical countries with humid and hot climates, for which it got its second name – “tropical”. The most susceptible to the appearance of papular miliaria are adults who are worse adapted to the heat than others. Frequent overheating in such patients can lead to depletion of sweat glands, the appearance of peeling and dry skin in the miliaria area.
The course of miliaria may be complicated by the addition of a secondary infection. In such cases, the contents of the bubbles become purulent, and the nodules turn into pustules with small pustules on the tops. Thus, the process can be transformed into pyoderma.
Miliaria diagnosis and treatment
The diagnosis usually does not cause difficulties for a doctor of any specialization. Therefore, a visual examination by a pediatrician or therapist is sufficient to confirm the diagnosis. In difficult cases, you may need to consult a dermatologist.
In the treatment of this disease, the main importance belongs to the elimination of overheating of the patient. This is facilitated by frequent ventilation of the room, air baths, water procedures, wearing less warm clothes and cotton underwear. In order to avoid miliaria in the hot summer, it is necessary to use room cooling with a fan or air conditioner. Adult patients with miliaria are advised to avoid physical activity in hot conditions or warm clothes. In the vast majority of cases, the symptoms of miliaria go away in the first 1-3 days after the termination of the factor causing it.
Local treatment may be used to accelerate recovery. Baths with a solution of calcium permanganate, chamomile, and a series help well with miliaria, after which the areas of rashes can be treated with a powder with zinc oxide or talc. With severe itching in adults, preparations with menthol and camphor, betamethasone ointment are used. The appearance of infectious complications with miliaria is an indication for local antimicrobial therapy with antiseptics and antibiotics.
Prevention of miliaria is to observe skin hygiene, maintain optimal room temperature, regular water procedures, eliminate situations that lead to severe miliaria. In summer, it is necessary to avoid prolonged exposure to the open sun. For people moving to hotter climatic conditions, gradual adaptation is desirable.
Separately, it is necessary to say about clothes. Underwear in direct contact with the skin should be “breathable” and not too tight. It is important that the clothes correspond to the weather and physical activity of a person. So, when doing sports or physical work, as well as in mobile children, clothes should be less warm.
To prevent pathology in children of the first year of life, it is necessary to avoid tight swaddling and wrapping too warm. Of great importance is the proper care of the baby’s skin, regular water procedures and air baths, good ventilation of the room, the use of high-quality diapers, cotton clothing and underwear.