Dermatologic Physical Exam

Primary Lesions

The earliest primary histologic lesion of miliaria is a crystalline intraepidermal vesicle (see Photo 38), which evolves into a small erythematous papule (see Photo 39). With prolonged occlusion, pustules may occur (see Photo 40).

Secondary Lesions

Secondary infection may lead to frank impetiginization.

Distribution

Microdistribution: Periporal (surrounds sweat duct orifices). Examination with a magnifier will demonstrate that the interspersed hair follicle openings are spared (see Fig. 10).

Macrodistribution: Large numbers of geometrically spaced tiny periporal papules arise symmetrically on covered areas of the trunk and in intertriginous regions. The face, arms, palms, and soles are spared.

Configuration

Grouped (tiny grouped geometrically spaced papules).

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