Miliaria rubra L74.0

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 18.12.2020

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Synonym(s)

lichen tropical; prickly heat; Red Dog; tropical lichen

Definition
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Acute, pruritic skin rash characterized by minute red papules and pustules, often occurring after exposure to heat (also in humid tropical climates). Miliaria rubra is caused by occlusion of the sweat gland duct in the epidermis ( stratum spinosum): Miliaria profunda (rarely observed in infants) is caused by occlusion of the dermal part of the sweat gland duct or at the transition to the epidermal papillae (stratum papillare). S.a.u. Anhidrosis, "thermogenic".

Occurrence/Epidemiology
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Especially in the tropics and for people who work in warm and humid environments, for obese people with stress hyperhidrosis. Development within weeks and months after heat exposure. Also in infants after the first weeks of life (see below miliaria).

Etiopathogenesis
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Thermoregulatory problems due to sweat retention caused by:
  • Tropical heat, high humidity, swelling of the horny layer, secretion, escape of sweat into the interstitium, possible rupture of the excretory duct.
  • Bacterial toxins.
  • Metal salts, toxic detergents, strong ion flow in iontophoresis.

Localization
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Adults: Covered areas of the body, especially the trunk. Face, palms of hands and soles of feet are always free.

Infants: Intertriginous areas, on the capillitium, face and trunk.

Clinical features
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Sowing of intensive red, itchy, punctiform spots, nodules, blisters and also pustules, which are no larger than 0,1-0,2 cm. In intertriginous areas, confluence and formation of extensive weeping areas with pustules after impetiginization are possible.

Histology
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Intra- or subepidermal vesicles, inflammatory infiltrate around the sweat gland ducts.

Differential diagnosis
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Folliculitis of different genesis.

Therapy
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Avoidance of any occluding influences (clothing, ointments); see also Miliaria.

Progression/forecast
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Cheap.

Literature
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  1. Ghislain PD et al (2002) Itchy papules of the axillae. Arch Dermatol 138: 259-264
  2. Kirk JF et al (1996) Miliaria profunda. J Am Acad Dermatol 35: 854-856
  3. Rogers M et al (1990) Giant centrifugal miliaria profunda. Pediatric dermatol 7: 140-146
  4. Tey HL et al (2014) In vivo imaging of miliaria profunda usinghigh-definition
    optical coherence tomography: diagnosis, pathogenesis, andtreatment
    . JAMA Dermatol 151:346-348
  5. Urbatsch A et al (2002) Pustular miliaria rubra: a specific cutaneous finding of type I pseudohypoaldosteronism. Pediatric dermatol 19: 317-319

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 18.12.2020