prickly heat

Prickly heat (miliaria rubra or crystallina) is something we see here in the South rather paradoxically only in the winter. This rash occurs usually on the trunk and perhaps the nape of the neck. It is fine, bumpy and itchy (intensely pruritic, as doctors are wont to say).

It is caused when a child who hasn't done any major sweating in a while (thus usually in the late autumn or early winter) goes out in the cold, appropriately bundled by his Mom to ward off the cold. He runs around like a bulky maniac, doing his Bib-the-Michelin-Man-on-speed imitation, but does not know to loosen his clothing. Those little sweat glands work fiendishly, pumping out sweat - which has nowhere to go, since the pores are stopped up tight with old skin cells, dried oil, and so forth. It exudes into the surrounding tissue, forcing with it the aforementioned old crud; said crud is intensely irritating to the tissue, hence the inflammation and rash.

So the rash is fine and bumpy - the miliaria part of the name. Then we get to choose: are the bumps more red and inflammed - rubra; or rather are they clear, sweat filled bumps with less inflammation - crystallina.

Treatment is dead simple. First, loosen the clothing! Next, when you bathe little Buddy, use a coarse washcloth to rub the skin a bit and open up the pores. If the redness or itching are disconcerting, you may apply god old hydrocortisone 1% ointment/cream available over the counter or even give some oral diphenhydramine (Benadryl®) in a dose of one teaspoon per thirty pounds of body weight. My Mom rubbed cornstarch on my prickly heat... I can't remember how well that worked, but Moms knew lots of good stuff back then.

Once the pores are open, no more opportunity for the rash. That is why we don't see it in the summer, when light clothing and profuse sweating are de rigeur.

Quite a lot to say about prickly heat, wouldn't you agree? I really should have gone into academic medicine...

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