Miliaria in a child: causes, treatment, symptoms

Pediatrician

Sayfulina

Maryam Zakareevna

32 years of experience

Pediatrician of the highest category, member of the Union of Pediatricians of Russia

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Miliaria in children under one year of age and older is a fairly common skin lesion, which is a rash caused by severe sweating or poor care of the child’s delicate skin. It is important to understand that the baby’s thermoregulation processes are not yet perfectly established, and therefore the slightest negative factors can cause an undesirable reaction - parents should not be scared and think that this is a rare phenomenon. Almost all kids go through this.

However, you shouldn’t treat this problem negligently either: ordinary heat rash without treatment tends to become more complicated and worse, and in this case, longer and more complex treatment will be required - it’s better not to let it get to that point.

Symptoms

Symptoms of prickly heat in children include:

The appearance of a characteristic rash on the neck, in the ear area, on the back of the head, along the hairline, armpits, in the upper chest, as well as on the back, in the groin folds and on the buttocks.
Small rashes in the form of bubbles with transparent contents. In more complex cases, these are reddish nodules with an inflamed rim. The rash reacts to temperature, so it can decrease or increase depending on the environment.
Weeping lesions - they occur when there is extensive damage to the skin.
Pustules, swelling, redness of the skin and a putrid odor. This is not so much a symptom of prickly heat in children, but a signal that a bacterial or fungal infection has joined it.
Soreness, itching and other unpleasant sensations that cause anxiety in the child make him capricious. This is not observed with ordinary heat rash, but if the condition is complicated, such negative factors will progress, simultaneously causing an increase in body temperature.

At any stage of heat rash in a child, even if it is very mild, it is necessary to consult a pediatrician. If complications arise, you should immediately consult a doctor - such issues are dealt with either by a pediatrician or a pediatric dermatologist.

What is prickly heat

Miliaria (heat rash) is a skin disease that often occurs in newborn babies.
The skin of a child under one year old is very sensitive to even the slightest environmental influences and illiterate care, as a result of which redness and rashes may appear on it. In itself, prickly heat in newborns is not dangerous; it cannot be contracted. However, inexperienced parents may mistake the symptoms of dangerous problems (allergies or infections) for signs of prickly heat, because they are often similar. But if prickly heat can be easily treated with home remedies, treatment of infections and allergies requires urgent medical attention.

Causes

The main cause of heat rash in a child is overheating, and it is caused by various factors, including:

Too warm, and synthetic clothes at that.
Untimely changing of diapers, especially in hot weather or in a warm room.
A minimal amount of air baths and infrequent bathing, due to which the skin is not cleansed and does not breathe.
Using cosmetics that are too oily and thick on the skin, which does not allow heat to be released properly.
Diseases associated with fever. Especially if parents also use warming treatment methods.

To overheating we will add such factors as allergies to various materials, friction and pressure of clothing, effect on irritated areas of feces and urine.

It may seem that the causes of heat rash in children are due solely to parental care errors, but this is absolutely not the case. There are children who themselves are prone to developing this condition. These are allergy sufferers, overweight children, children with various endocrine diseases (for example, diabetes). Also at risk are formula-fed children and premature newborns. When caring for such babies, you should be especially attentive to the condition of the skin and body.

Why does sweat rash occur?

Miliaria occurs due to blockage of the ducts of the sweat glands, which is facilitated by the structural features of the skin of young children and external conditions: if the child overheats and, accordingly, sweats a lot. Thus, a rash may appear if a child spends a long time in a hot room with high humidity, is wrapped up too warmly when walking, is dressed in tight clothes made of synthetic fabrics, or is wearing diapers in the heat. Sweat is not removed outside, remains in the skin and causes redness and rashes.

It is important!

Heat rash can be caused by frequent or excessive use of baby creams, especially fatty ones, and baby cosmetic oils.
Heat rash often occurs in children with a thick build and pronounced folds on the arms and legs.

As for the characteristics of the skin of newborns, it is still thin, and the excretory ducts of the sweat and sebaceous glands continue to form, so it cannot fully perform protective functions and quickly loses moisture. All this leads to the fact that the ducts of the sweat glands are easily clogged. In addition, babies cannot say that they are hot or take off uncomfortable tight clothes, and mothers tend to dress them warmer to be on the safe side.

Diagnostics

A pediatric dermatologist or pediatrician will examine the child and interview the parents, as well as a series of studies to rule out dermatitis, chickenpox, scarlet fever and many other diseases with similar symptoms. Most often, a visual examination is enough, but tests (scraping) may be required to help identify the causative agent of a secondary infection (if one is observed). A general and biochemical blood test is often done, as well as an analysis of the contents of the vesicles - it all depends on the recommendations of the attending physician.

Doctor Komarovsky's opinion

Evgeniy Komarovsky warns that a rash is not a cause, but a consequence, so first of all it is necessary to establish what caused it. Factors in the appearance of skin rashes can be diathesis, mechanical damage, various infections, allergies and even a reaction to blood clotting. First, you should try to determine whether the rash is dangerous or not, and then look for its culprit. If there are no signs of infectious diseases, the baby is cheerful and active, and of all the symptoms there is only a rash - the cause may be allergies, prickly heat or insect bites. Mommy will have to remember the previous day and try to figure out what could have caused the baby to get sick - buying new clothes, eating an orange, or being bitten by small insects.

Doctor Komarovsky warns! If the rash on the child’s skin has elements of hemorrhage, and the baby is vomiting, call an ambulance immediately!

The beloved doctor states that with the onset of heat, the appearance of prickly heat is not at all uncommon. A cluster of small pimples surrounded by reddened skin most often appears on the neck, gradually spreading to the face, back and chest, and behind the ears. Dr. Komarovsky advises diluting a teaspoon of soda in a glass of water and wiping the affected areas with a cotton ball soaked in the solution, lightly patting it several times a day. You can also use simple starch, using it instead of powder, but the main thing is to keep the baby undressed as often as possible in the heat. Let your baby take a break from diapers and tight clothes, and let his skin enjoy the touch of cool air.

Treatment

Usually, treatment of prickly heat in a child is carried out comprehensively and includes the following points:

Maintaining optimal temperature in the house - no more than 20-22 degrees Celsius. The same goes for humidity, which needs to be monitored - 50-70%.
The right choice of clothes. It must be appropriate for the temperature and not be synthetic or too dense.
Regular hygiene procedures - washing, bathing using gentle cosmetics designed specifically for children's delicate skin.
Regular diaper changes. Your baby's skin should always be clean and dry.
Use of medications and other means prescribed by a doctor. Sometimes decoctions of medicinal herbs are allowed, but only when the doctor allows it. For the rest, specially selected ointments, powders and other medications are used. In difficult cases, antifungal drugs and antibiotic-based ointments can be used - but parents should not purchase such products on their own.

As a rule, when prickly heat appears in a child, the prognosis is good. After establishing hygiene procedures, the problem disappears quite quickly. If the baby’s immunity is severely weakened, and a dangerous infection develops against the background of prickly heat, there is a risk of complications. In this case, the treatment will be longer and more complex, and in exceptional cases it will require hospitalization of the child.

If your baby exhibits symptoms of infant heat rash, do not wait until complications begin - be sure to contact pediatricians or dermatologists at Meditsina JSC - get examined by a doctor, get an accurate diagnosis and an effective treatment plan.

What you should never do if you have heat rash in a child

Before visiting specialists, many parents try to help their child on their own and use various tips from the Internet. This should not be done under any circumstances. We have compiled a short list of what is prohibited:

Squeeze and open the blisters on the baby’s skin.
Cover inflammations and blisters with iodine or brilliant green, as well as other aggressive agents.
Moisturize the skin with any available means. Heavy moisturizing creams are often used, which in this case are strictly contraindicated.
Dry wet areas with rough materials or sudden movements. If it is necessary to remove moisture, this is done with very clean, soft and highly absorbent material - with extremely careful and smooth movements.

But it is best to immediately visit a doctor and get detailed advice about what you can and cannot do.

Classification

There are several types of prickly heat:

Red - individual nodules and blisters are surrounded by reddened skin, but do not merge. It most often occurs in skin folds - in the groin, armpits, and neck. The rash bothers the baby with severe itching and pain on contact. Usually an annoyance for one to two weeks.
Crystalline - small silver or white bubbles appear on the baby’s torso, face, and neck. Merging, they form quite large spots and burst easily, leaving flaky areas in their place. The rash does not torment the baby with itching or pain and dries out after two to three days.
Papular - appears a few hours after the baby sweats. Small flesh-colored bubbles appear on the dry skin of the limbs and torso and, after some time, disappear without a trace.

Other types, white and yellow, are complicated forms.

What is commonly called prickly heat?

The formation of small spots or pimples of pink and red color, which are located in the folds of the skin and in areas of increased sweating, is called prickly heat.

Sometimes small pimples may contain a small amount of fluid and become crusty when damaged. This type of rash most often forms in the summer or after sleep, when the child is exposed to the greatest sweating process.

Miliaria can form in the first days after birth and in the absence of proper care for the child, the manifestations become systematic.

Most often, a newborn shows virtually no signs of heat rash, however, there may be cases when a newborn becomes less active, this is due to the formation of a large area of skin lesions.

How long does it take?

With active treatment, the child’s miliaria goes away after 3-5 days. Of course, a lot depends on what drugs and agents were used in therapy, when treatment was started, and whether the doctor’s recommendations were followed.

For example, advanced heat rash with infection can last up to 10-14 days, sometimes longer. Much also depends on the type of disease. The crystalline and deep forms of miliaria go away much faster and for them to disappear, it is often enough to exclude an irritating factor, for example, high temperature in a child’s room.

Miliaria rubra may persist because it develops on the outer surface of the skin and is most susceptible to various factors such as overheating, infection, and mechanical irritation from rubbing against clothing and underwear.

Rashes in babies

Babies are generous with various rashes. According to the “good” tradition, most of them are considered allergic with all the consequences - a strict diet for a nursing mother, transfer to artificial feeding, prescription of medicinal mixtures, etc. In fact, true allergic rashes in infants are not that common. Allergic diseases affecting the skin in infants include: atopic dermatitis, acute urticaria and Quincke's edema. Acute urticaria is extremely rare in infants - it is an acute allergic reaction in the form of peculiar blistering-type rashes (like a nettle burn, hence the name), which suddenly appear on the skin and just as suddenly disappear without leaving any trace behind, usually do not exist on the skin for longer than a day and are accompanied by severe itching, which manifests itself in the child’s general anxiety. The most common causes are food proteins (for example, cow's milk), viral infections, insect bites and medications (for example, antibiotics). In severe cases, it may be accompanied by swelling and redness of the soft tissues of the face, neck, larynx, arms, legs, genitals or abdominal cavity - Quincke's edema, which requires immediate medical attention.

Let's figure out what is most often unfairly called an allergy:

Erythema toxicum of newborns is a transient, benign rash whose exact cause is unknown (possibly due to skin irritation by environmental factors).

Appears at birth or in the first 24–48 hours of life. Localization - face, torso, limbs, except palms and soles. Disappears on its own within 5–7 days, sometimes 3 weeks. Does not require treatment.

Newborn acne (infantile acne, neonatal pustulosis) is caused by stimulation of the baby's sebaceous glands by androgens.

The peak of rash occurs in the 3rd week of life. It is most often localized on the face, sometimes spreading to the scalp, less often to the collar area. Resolve spontaneously. The skin requires cleansing and moisturizing; in some cases, the use of medicated creams may be required.

Miliaria is a rash that occurs in poorly “ventilated” areas as a result of blocked sweat glands. Can occur at any age.

Localization - folds of skin, buttocks and back surface of the body, sometimes the face (after sleep). Depending on the depth of the lesion, there are crystalline prickly heat, prickly heat, deep prickly heat (superficial).

The duration of the rash ranges from several hours to several days.

Treatment - cool water baths, air baths, prevention of overheating. Calamine-containing lotions and corticosteroid and antibiotic creams may be used to treat some cases of prickly heat and miliaria.

Seborrheic dermatitis is a skin disorder that forms on sebum-rich areas of the skin. The exact cause is unknown (a certain role is played by the skin saprophyte - the Malassezia fungus, which grows well and multiplies in sebaceous secretions).

It can be focal or widespread, dermatitis with pityriasis-like scales, which can form a crust (“cap”, gneiss) on the scalp.

Favorite localization is the scalp, face, folds (!).

It can begin from the 1st - 2nd week of life or later, and resolves spontaneously over several weeks or months.

Treatment involves softening the crusts with oil or cream and then removing them, moisturizing the skin and, in some cases, applying antifungal and anti-inflammatory creams.

Simple contact dermatitis is a nonspecific damage to the skin due to prolonged or repeated exposure to a number of substances - saliva, fruit juices, foaming bath products, detergents (their residue on the walls of the bathtub), etc. In infants, saliva often causes dermatitis in the contact area with the pacifier and in the folds of the neck.

As a rule, elimination of the offending agent and short-term administration of anti-inflammatory creams quickly leads to recovery, but some children are so sensitive that it is almost impossible to identify the causative factor.

Diaper dermatitis (a prototype of contact dermatitis) is a skin lesion that occurs under the influence of physical (overheating), chemical, enzymatic (contact with sweat, urine and feces) and microbial factors. Localization - area of the diaper or diaper area.

Treatment is carried out using the abbreviation ABCDE (air, barrier, cleansing, diaper, education). Frequently changing diapers, washing the skin and drying it thoroughly helps. Dermatitis is effectively prevented by applying products to clean skin that completely cover it (vaseline, zinc paste). In persistent cases, medicated creams containing corticosteroids, antibiotics, or antifungals may be recommended.

And now a few words about AD:

Atopic dermatitis is a chronic allergic inflammation of the skin, genetically determined, associated with loss of the skin barrier and, therefore, accompanied by dryness, itching and various rashes. In a third (!) of cases it is combined with food allergies (the most common “culprits” are cow’s milk, chicken eggs, wheat, fish, soy, nuts).

Most often it starts no earlier than 3 months of life.

The most common localization up to 2–3 years is the face (cheeks, forehead, chin), convex parts of the limbs (extensor surfaces) and the torso; it never occurs in folds in infants (!).

Exacerbations are triggered by various factors - stress, dry air, sweat, food (histamine liberators), infections, contact with tobacco smoke, animal hair, rough fabric, detergent residues on clothes, etc.

It is treated with careful skin care and the use of anti-inflammatory creams.

There are also:

Pseudoallergic reactions are reactions that are externally similar to allergic ones (for example, various rashes), but are not such, due to the non-immune mechanism of their development.

The reason is the increased content of histamine (tyramine, serotonin) in foods, or the ability of foods to enhance the release of these substances in the body, or their increased absorption, due to pathology of the gastrointestinal tract (enzymopathies, inflammation in the intestinal wall, etc.). These products include chocolate, cocoa, strawberries, citrus fruits, honey, sauerkraut, marinades and spices, seafood, fish, caviar, pork, mushrooms, cheeses, nuts, smoked meats, preservatives, dyes and flavor enhancers.

Treatment includes dietary advice, skin care, and in some cases, antihistamines and anti-inflammatory creams.

The clinical manifestations of atopic dermatitis, simple contact dermatitis in highly sensitive children and the manifestation of pseudo-allergic reactions are very similar to each other, so the main task remains the creation of a “skin barrier” by constantly moisturizing the skin with emollients, stopping exacerbations with anti-inflammatory creams and excluding exacerbation factors.

And the last thing:

Skin infections - herpes virus, staphylococcal pemphigus, candidiasis also occur in infants, do not forget about them. You should consult a doctor immediately if the child is lethargic, has a fever, refuses the breast or bottle, skin rashes are accompanied by pus or are covered with purulent crusts, there are blisters or a group of blisters, erosion (violation of skin integrity), severe swelling and redness of the skin.

Author:

Eroshkina Maria Sergeevna pediatrician