prickly heat is a damaging problem

Ellen Says:Miliaria (miliaria rubra, sweat rash, heat rash, or prickly heat) is a skin disease marked by small and itchy rashes. Miliaria is a common ailment in hot and humid conditions, such as in the tropics and during the summer season. Although it affects people of all ages, it is especially common in children and infants due to their underdeveloped sweat glands.

Symptoms of miliaria include small red rashes, called papules, which may itch or more often cause an intense 'pins-and-needles' prickling sensation.

These may simultaneously occur at a number of areas on a sufferer's body, the most common including the face, neck, under the breasts and under the scrotum. Other areas include skin folds, areas of the body that may rub against clothing, such as the back, chest, and stomach, etc. A related and sometimes simultaneous condition is folliculitis, where hair follicles become plugged with foreign matter, resulting in inflammation.

The symptoms relating to miliaria should not be confused with shingles as they can be very similar. Shingles will restrict itself to one side of the body but also has a rash-like appearance. It is also accompanied by a prickling sensation and pain throughout the region. Those who suspect they have shingles and not miliaria should seek medical advice immediately as the sooner antivirals are taken, the better.

Medical assistance should be sought for the first episode of a rash with the appearance of miliaria. The differential includes several conditions which an experienced practitioner should be able to recognise and may require treatment distinct from the usual measures taken for miliaria. In most cases the rash of miliaria will resolve without intervention. However, severe cases can last for a number of weeks and cause significant disability. General measures should be recommended for all patients, including moving to an air-conditioned environment if possible, avoiding sweat-provoking activities and occlusive clothing, and taking frequent cool showers.

It has been suggested that the use of topical antibacterials (including the use of antibacterial soaps) may shorten the duration of symptoms in miliaria rubra even in the absence of obvious superinfection. Other topical agents which may reduce the severity of symptoms include anti-itch preparations such as calamine or menthol and/or camphor based preparations, and topical steroid creams, however caution should be used with oil-based preparations (ointments and oily creams as opposed to water based or aqueous lotions) which may increase blockage to the sweat glands and prolong duration of illness.

Other agents have been investigated including supplemental vitamin A and C and vitamin A based medications, but it is worth noting that there is little scientific evidence supporting any of the above treatments in terms of actually reducing the duration of symptoms or frequency of complications.