General Measures

Victims should avoid any circumstance that provokes sweating, as this will exacerbate symptoms and reactivate the eruption. High ambient temperatures, especially with high humidity or while in tight occlusive clothing, will prolong the glandular plugging. Clothing should be light, loose, and absorbent to wick moisture away from the skin surface.

Figure 10: Microdistribution of miliaria.

Topical Therapy

The only measure ever shown to speed resolution of miliaria is epidermal lubrication. Consider using a bland OTC lubricant that contains a modest concentration of urea and an a-hydroxy acid. Topically applied anhydrous lanolin has also been reported as beneficial. Recent data suggest that use of an antibacterial bath soap might be beneficial, and in refractory cases, intermittent use of a benzoyl peroxide wash or lotion may be helpful.

Systemic Therapy

Systemic antibiotics should be used where there is clear evidence of secondary infection. They should be chosen on the basis of culture and sensitivity studies. These agents have no apparent effect on the primary process and are usually not required to treat pure miliaria. In the rare instance in which such therapy is considered for miliaria without secondary infection, culture for sensitivity should be obtained from several duct orifice lesions. Initial therapy should be directed at the spectrum of sensitivity of S. epidermidis and the antibiotic should preferably be one that is readily delivered to both the sweat gland and skin surface.

Conditions That May Simulate Miliaria

Viral Exanthems

Spring and summer viral illnesses may be confused with miliaria. These are usually of shorter duration and are associated with constitutional symptoms such as coryza, sore throat, fatigue, fever, or malaise. Cervical adenopathy is also common and is not seen with pure miliaria. Remember that miliaria can be a sequela of viral illness and both can have eruptions that may occur simultaneously or in sequence.

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