Miliaria
Miliaria (miliaria rubra, sweat rash or prickly heat) is a skin disease marked by small and itchy rashes. Miliaria is a common condition 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.
Reason for occurring
Miliaria (Prickly Heat) occurs when the sweat gland ducts get plugged with dead skin cells and bacteria such as Staphylococcus epidermidis, a common bacteria that occurs on the skin which is also associated with acne. The trapped sweat leads to irritation (prickling), itching and to a rash of very small blisters, usually in a localised area of the skin.
Clinical Features
Symptoms of miliaria include small red rashes, called papules, which may itch or more often cause an intense 'pins-and-needles' prickling sensation. These rashes 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.
Once triggered, an attack of miliaria commonly lasts 5-6 weeks because the plugs which form in the sweat duct openings can only be cast off by the outward growth of the sweat duct cells. This takes several weeks. Treatment cannot influence this process but may be used to relieve symptoms.
Other types of Miliaria
In a similar mild condition called miliaria crystalina, instead of small rashes, there are tiny blisters that look like beads of perspiration. In miliaria profunda, a severe form of miliaria caused by a complication due to repeated outbreaks of miliaria rubra, the sweat ducts are completely blocked. This inability to sweat may cause the patient to be prone to heat exhaustion.
Prevention
Prickly heat can be prevented by avoiding activities that induce sweating, using air conditioning to cool the environment, wearing light clothing and in general, avoiding hot and humid weather. If that is not possible, and especially if air conditioning is unavailable or unaffordable, then taking multiple showers throughout the day (and night as well if needed) to unplug and clean the sweat glands is the best defence against it.
Treatment
There is currently little in the way of specific medical treatment, but in most cases the rashes disappear by themselves within several weeks. Staying in an air-conditioned environment to avoid sweating will speed-up the healing process and lessen symptoms. Anti-itch lotions, such as calamine and topical steroid creams can be used to sooth and control the itching. Oil based products slows the defoliation process and should be avoided. Antibiotics and topical antiseptics are used to prevent bacterial blooms, reducing the chances of the sweat glands being plugged and causing inflamations. In some cases, vitamin A and C supplements can help shorten the duration and severity of the symptoms. Prickly heat powders, using antibacterial agents and ingredients like menthol and camphor with mild analgesic and cooling properties, can be applied to the affected areas to relieve the itching and discomfort. Healing takes time even when bacteria are reduced as new sweat gland cells need time to regrow as the damaged cells defoliate.
Instead of medicating, it is usually best to simply keep the skin clean by taking multiple showers to keep affected areas clean and sweat free. Mild antibacterial soaps may be helpful as well to slow spread and prevent future outbreaks. In most cases, these simple steps alone will make the rashes disappear naturally in a few days. If they persists, it may be advisable to consult a doctor in case a more serious infection is occurring.