Summary
Definition
History and exam
Key diagnostic factors
- nonfollicular vesicles and papules (all types)
- asymptomatic eruption (crystallina)
- clear noninflammatory vesicles (crystallina)
- fragile vesicles (crystallina)
- paroxysmal pruritus and stinging (rubra)
- erythematous papulovesicles (rubra)
- anhidrosis (profunda)
- compensatory hyperhidrosis (profunda)
- flesh-colored papules (profunda)
Other diagnostic factors
- desquamative healing (crystallina)
- weakness and malaise (profunda)
- dyspnea (profunda)
- tachycardia (profunda)
- hyperpyrexia (profunda)
Risk factors
- profuse sweating
- excessive heat and humidity
- occlusive clothing
- febrile illness
- repeat episodes of miliaria rubra (for miliaria profunda)
- ultraviolet light exposure
- neonatal age
- cholinergic medications
- isotretinoin
- doxorubicin
- staphylococcal scalded skin syndrome
- atopic dermatitis
Diagnostic investigations
Investigations to consider
- Tzanck smear
- viral direct fluorescent antibody (DFA) or culture
- viral polymerase chain reaction
- bacterial culture
- fungal culture
- potassium hydroxide (KOH) prep
- skin biopsy
Treatment algorithm
all patients
Contributors
Authors
Brian L. Swick, MD
Clinical Professor
Departments of Dermatology and Pathology
Iowa City Veterans Affairs Medical Center
Iowa City
IA
Disclosures
BLS declares that he has no competing interests.
Peer reviewers
Hobart W. Walling, MD, PhD
Dermatology Physician
Town Square Dermatology
Coralville
IA
Disclosures
HWW declares that he has no competing interests.
John English, MBBS, FRCP
Consultant Dermatologist
Department of Dermatology
Queen's Medical Centre
Nottingham University Hospitals
Nottingham
UK
Disclosures
JE declares that he has no competing interests.
Andrew D. Lee, MD, FAAD
Consultant Dermatologist
Yadkin Valley Dermatology
Affiliate of Hugh Chatham Memorial Hospital
Elkin
NC
Disclosures
ADL declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Wenzel FG, Horn TD. Nonneoplastic disorders of the eccrine glands. J Am Acad Dermatol. 1998 Jan;38(1):1-17; quiz 18-20. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Fox-Fordyce disease (apocrine miliaria)
- Primary varicella infection
- Disseminated varicella-zoster infection
More Differentials
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