Clinical Feature of Miliaria

There are 3 types of miliaria; miliaria crystalline, miliaria rubra, and miliaria
profunda. There are several differences of each type.

a. Miliaria Crystallina
Miliaria crystalina usually affect neonates with age younger than 2 weeks
and adult who are febrile or recently moved to a place with topical climate.
The lesion appear in several days to weeks by sun weather exposure and
disappear in hours to days. Mostly miliarias crystalline are asymptomatic.

Clinical manifestation:

- Lesions are clear, superficial vesicles that are 1-2 mm in diameter.

- Lesions occur in crops and are often confluent, without any
surrounding erythema.
- In infants, lesions tend to occur on the head, neck, and upper part of
the trunk.
- In adults, lesions occur on the trunk.
- Lesions rupture easily and resolve with superficial branny
desquamation.

b. Miliaria Rubra
This type of miliaria usually can be found in neonates’ age 1-3 years old
and adult who life in place with hot weather and humid. Lesion can be
occur several days after hot condition expose but more disposed to occur
in several months after exposure of hot and humid condition. The lesion
will disappear after the patient is removed from hot and moist
environment. Lesion cause intense pruritus and stinging that is exacerbated
by fever, heat, or exertion. Patient may report fatigue and heat intolerance,
and decreased or absent sweating at the affected site.

Clinical manifestation:
 - Lesions are uniform, small, erythematous papules and vesicular
papules on a background of erythema.
- Lesions occur in a nonfollicular distribution and do not become
confluent.
- In infants, lesions occur on the neck and in the groin and axillae.
- In adults, lesions occur on covered skin where friction occurs; these
areas include the neck, scalp, upper part of the trunk, and flexures. The
face and volar areas are spared.
- Lesions may occur in erythematous patches similar to sunburn.
- In late stages, anhidrosis is observed in affected skin.

c. Miliaria Profunda

This type mostly happened in someone who life in tropical country and has
recurrent episode of miliaria rubra. Lesion develop within minutes or
hours after stimulation of sweating. These lesion resolve quickly, usually
in less than a hour after the stimulus that cause sweating is removed.
Mostly the lesions are asymptomatic. Patients may report increased
sweating in unaffected skin; swollen lymph nodes; hyperpyrexia; and
symptoms of heat exhaustion, which include dizziness, nausea, dyspnea,
and palpitations.

A rare giant centrifugal variant of miliaria profunda has been reported in 2

infants, each at about age 3 months, who presented with symmetrical
asymptomatic lesions on the trunk and extensor extremities after a low-
grade fever. Unlike most forms of miliaria, the lesions in these children
persisted for months

Clinical manifestation:

- Lesions are firm, flesh-colored, nonfollicular papules that are 1-3 mm

in diameter.
- Lesions occur primarily on the trunk, but they can also appear on the
extremities.
- Lesions are transiently present after exertion or other stimulus that
results in sweating.
- Affected skin shows diminished or absent sweating.
- In severe cases that lead to heat exhaustion, hyperpyrexia and
tachycardia may be observed.