Trip Answers

Question answered:11/07/06 Warning! this question is over two years old.

We have been unable to find any clinical trials or guidelines that deal with prickly heat (also called miliaria).  We found three eTextbook articles.

GP Notebook has a chapter [1] which includes a section on management, which states:

“preventive measures
 - keep cool and slowly acclimatise
 - the new varieties of sun cream with UVA protection may help

treatment
 - antihistamines”

The eMedicine article contains more information [2], this reports (in the medical care section):

“- No compelling reason to treat miliaria crystallina exists because this condition is asymptomatic and self-limited.
 - Miliaria rubra can cause great discomfort, and miliaria profunda may lead to heat exhaustion. Treatment of these conditions is warranted.
 - The prevention and treatment of miliaria primarily consists of controlling heat and humidity so that sweating is not stimulated. Measures may involve treating a febrile illness; removing occlusive clothing; limiting activity; providing air conditioning; or, as a last resort, having the patient move to a cooler climate.
 - Topical treatments that have been advocated involve lotions containing calamine, boric acid, or menthol; cool wet-to-dry compresses; frequent showering with soap (although some discourage excessive use of soap); topical corticosteroids; and topical antibiotics.
 - The topical application of anhydrous lanolin has resulted in dramatic improvement in patients with miliaria profunda.
 - The prophylaxis of miliaria with oral antibiotics is reported. Patients have also been treated with oral retinoids, vitamin A, and vitamin C, with variable success. To our knowledge, no controlled trials have been conducted to demonstrate the effectiveness of any of these systemic therapies.
 - Antimicrobial agents are effective in suppressing experimentally induced miliaria.”

Finally, the New Zealand DermNet chapter [3], this reports the following in the treatment section:

“- Avoid further sweating Even if this is achieved for only a few hours a day, as in an air-conditioned office or bedroom, considerable relief is experienced. For the very susceptible person a move away from tropical climates may be essential.
 - Do not irritate the skin Avoidance of excessive clothing, friction from clothing, excesssive soap and contact of the skin with irritants will reduce the liability to miliaria. Shirts and blouses should be made of the new breathable synthetic fabrics where available, otherwise of cotton.
 - Cool water compresses and good ventilation will soothe inflamed areas.
 - Calamine lotion Calamine is probably as effective as anything for relief of discomfort, but because of its drying effect an emollient may subsequently be required.
 - Topical steroids For more marked cases, mild topical steroids often give reasonable relief of symptoms while natural resolution of the condition is awaited.
 - Antiseptics Antiseptics and antistaphylococcal antibiotics can combat bacterial overgrowth.”

The latter two articles also include sections dealing with issues such as cause, diagnosis etc.

References

1) http://www.gpnotebook.co.uk/simplepage.cfm?ID=-382402548
2) eMedicine. Miliaria. 2005 (http://www.emedicine.com/derm/topic266.htm)
3) http://www.dermnetnz.org/hair-nails-sweat/miliaria.html
 

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