Case history
Case history #1
A 60-year-old woman, hospitalised for methicillin-resistant Staphylococcus aureus cellulitis, developed a diffuse, asymptomatic eruption over 12 hours consisting of numerous fragile, fluid-filled vesicles on the trunk and extremities. The patient was receiving intravenous vancomycin and was both bedridden and febrile. Examination revealed a diffuse eruption on the trunk and proximal extremities composed of multiple 2- to 4-mm, non-folliculocentric, superficial vesicles on a non-inflammatory base. The vesicles had the appearance of drops of water and ruptured spontaneously with slight friction. As the patient recovered and was able to walk, the eruption spontaneously resolved with a superficial, "branny", desquamative appearance (miliaria crystallina).
Case history #2
A 20-year-old man, who was on a several-month expedition to the Amazon rain forest, developed a pruritic eruption on the neck, back, and waistline area. He described the pruritus as stinging and intermittent, being most noticeable in the late afternoon and associated with heavy sweating under the tropical sun. Following the paroxysms of pruritus, the man noted decreased sweating at the sites of involvement. Examination revealed multiple 2- to 4-mm, non-follicular, erythematous papules with a central vesicle on the sides of the neck, upper back, and the abdomen at the waistline area (miliaria rubra).
Other presentations
Miliaria profunda is usually seen in tropical environments after multiple episodes of miliaria rubra.[1] The variant is characterised by asymptomatic, flesh-coloured papules on the trunk and extremities with associated anhidrosis that can lead to hyperpyrexia and heat exhaustion.[1][4] Miliaria crystallina and miliaria rubra also occur in the neonatal period with miliaria crystallina commonly occurring on the head, neck, and upper trunk at approximately 1 week of age.[1][5] Miliaria rubra affects infants in flexural areas and, unlike adults, affects the face and scalp at 11 to 14 days.[1][5] The vesicles of miliaria crystallina occur on a non-inflammatory base, are asymptomatic and fragile, and spontaneously resolve upon cooling of the patient, with a "branny", desquamative appearance.[1] Miliaria rubra in contrast is inflammatory in appearance and extremely pruritic with paroxysms of stinging and pruritus occurring with stimuli that induce sweating and is slower to resolve.[1][2]
Use of this content is subject to our disclaimer