Miliaria (Synonyms: Prickly Heat; Heat Rash; Lichen Tropicus; Red Gum; Strophulus)
What do you understand by miliaria?
An acute mildly inflammatory disorder of the sweat-glands, characterized by the appearance of minute, discrete but closely crowded papules, vesico-papules, and vesicles.
Describe the symptoms of miliaria.
The eruption, consisting of pin-point to millet-seed-sized papules, vesico-papules, vesicles, or a mixture of these lesions, discrete but usually numerous and closely crowded, appears suddenly, occurring upon a limited portion of the surface, or, as commonly observed, involving a greater part or the whole integument. The trunk is a favorite locality. The papular lesions are pinkish or reddish, and the vesicles whitish or yellowish, surrounded by inflammatory areola, thus giving the whole eruption a bright red appearance—miliaria rubra. Later, the areolæ fade, the transparent contents of the vesicles become somewhat opaque and yellowish-white, and the eruption has a whitish or yellowish cast—miliaria alba. In long-continued cases, especially in children, boils and cutaneous abscesses sometimes develop; and it may also develop into a true eczema.
Itching, or a feeling of burning, slight or intense, is usually present.
What is the course of the eruption?
The vesicles show no disposition to rupture, but dry up in a few days or a week, disappearing by absorption and with slight subsequent desquamation; the papular lesions gradually fade away, and the affection, if the exciting cause has ceased to act, terminates.
What is the cause of miliaria?
Excessive heat. Debilitated individuals, especially children, are more prone to an attack. Being too warmly clad is often causative.
What is the nature of the disease?
The affection is considered to be due to sweat-obstruction, with mild inflammatory symptoms as a cause or consequence, congestion and exudation taking place about the ducts, giving rise to papules or vesicles, according to the intensity of the process.
How would you distinguish miliaria from papular and vesicular eczema, and from sudamen?
The papules of eczema are larger, more elevated, firmer, slower in their evolution, of longer duration, and are markedly itchy.
The vesicles of eczema are usually larger, tend to become confluent, and also to rupture and become crusted; there is marked itchiness, and the inflammatory action is usually severe and persistent.
In sudamen there is absence of inflammatory symptoms.
What is the prognosis of miliaria?
The affection, under favorable circumstances, disappears in a few days or weeks. If the cause persists, as for instance, in infants or young children too warmly clad, it may result in eczema.
What is the treatment of miliaria?
Removal of the cause, and in debilitated subjects the administration of tonics; together with the application of cooling and astringent lotions, as the following:—
℞ Aeidi carbolici, ................................. ʒss-ʒj
Acidi borici, .................................... ʒiv
Glycerinæ, ...................................... fʒj
Alcoholis, ...................................... f℥ij
Aquæ, ............................................ ℥xiv. M.
This is sometimes more efficient if zinc oxide, six to eight drachms, is added.
Lotions of alcohol and water or vinegar and water, and also the various lotions used in acute eczema, are often employed with relief.
Dusting-powders of starch, boric acid, lycopodium, talc, and zinc oxide are also valuable; the following combination is satisfactory:—
℞ Pulv. acidi borici,
Pulv. talci veneti,
Pulv. zinci oxidi,
Pulv. amyli, ..........................āā......... ʒij. M.
Probably the best plan is to use a lotion and a dusting-powder conjointly; dabbing on the wash freely, allowing it to dry, and then dusting over with the powder.