Prickly Heat

This is a pruritic, maculopapular, erythematous rash over clothed areas of the body. Also known as lichen tropicus, miliaria rubra, or heat rash, it is an acute inflammation of the sweat ducts caused by blockage of the sweat pores by macerated stratum corneum. The ducts become dilated under pressure and ultimately rupture, producing superficial vesicles in the malpighian layer of the skin on a red base. Itching is the predominant clinical feature during this phase and is treated successfully with antihistamines. Prickly heat can be prevented by wearing clean, light, and loose-fitting clothing and avoiding sweat-generating situations. The use of talc or baby power is of no benefit. Sometimes, ducts become secondarily infected with Staphylococcus aureus. Chlorhexidine in a light cream or lotion is the treatment of choice in the acute phase.

With prolonged heat exposure, a keratin plug fills the duct, causing obstruction in the stratum malpighian layer. When the duct ruptures a second time, the resultant vesicle will be driven deeper into the dermis. This rash simulates the white papules of piloerection and is not pruritic. This is known as the profunda stage of prickly heat and can readily advance into a chronic dermatitis. Infection with S. aureus is a common complication and requires the use of dicloxacillin or erythromycin. The skin can be desquamated by applying 1% salicylic acid to the affected area three times a day. Caution should be used to avoid salicylate toxicity.

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