Monday, September 29, 2014

What is a Prickly, Heat Rash: Heat Rash Versus Prickly Heat Rash



In order to understand the nature of prickly heat rash, it is important to differentiate between heat rash and prickly heat rash.

Heat rash is a generic name for different kinds of skin problems that come from excessive heat exposure or overheating. These include prickly heat rash or miliaria, urticaria or hives and sweat retention. (1)

Prickly heat rash or miliaria affects infants, young children and adults of any age, particularly during the summer time or especially in areas where the climate tends to be relatively humid.

“Prickly heat rash is a common skin condition that consists of an intense itch and feels (sic) prickly or even stings (sic) due to overheating. It usually appears on parts of the body commonly covered by clothes, for instance the back, neck or abdominal area, chest and groin. The disease is commonly known as miliaria.” (2)

Usually, prickly heat rash is not a serious condition, but “…it can cause a malfunction in the normal heat regulation mechanism of the body, which may lead to fever and a deep sensation of illness.” (3)

Prickly heat rash is usually easy to diagnose. Most parents will recognize the symptoms, as it is relatively common in infants.    

When the hair follicles and sweat glands in the skin become occluded, blocked or plugged, tiny, pinpoint, pink to clear bumps form on the skin resulting in inflammation and itchiness.

For some, the itchiness from the body salt released through the sweat glands is relatively minor, while for others, it may take on the appearance of a more severe skin irritation with red or pink patches of skin, raised bumps, welts or hives.

“In a hot and humid environment, the excess of perspiration damages the cells on the surface of the skin. These damaged cells form a barrier that traps sweat beneath the skin in small bumps or blisters. Eventually, these bumps or blisters will burst and release the sweat. When this happens, there is a stinging or prickly sensation. Additionally, the sweat glands can also be plugged with bacterium from the staphylococcus family, which are commonly present in the skin.” (4)     

While a prickly heat rash can affect any part of the body, it also tends to occur where there are folds in the skin. This can include areas under the chin, arms or breasts, skin creases in the groin or buttocks, as well as the inner aspect of elbows or knees. These areas are especially vulnerable because moisture accumulates here.

There are four different kinds of prickly heat rash or miliaria, namely, clear or miliaria crystalline, white/yellow or miliaria pustulosa, red or miliaria rubra and deep or miliaria profunda. (5)

Most prickly heat rashes will resolve within a few days. If this does not happen, seeking professional medical advice may be necessary to rule out other factors including possible bacterial infection, allergens, eczema or other, more serious, medical conditions.

Understanding the nature of prickly heat rash is important with respect to its correct diagnosis and treatment.
Because prickly heat rash usually involves an elevated body temperature, the symptoms presented may be resolved by remaining in a cool environment of approximately 21-22 degrees Celsius. Air conditioning is often helpful for those who are prone to prickly heat rash in the summer. The use of fans may help to lower and stabilize the room temperature.

Maintaining good hydration of the body at all times, is important because increasing fluids reduces the body temperature and flushes out excess salt or other infections. Increasing one’s water consumption, particularly when it is hot, is often helpful.  

Showering or bathing regularly, especially when it is hot and humid is important, particularly when there is excessive heat exposure or after engaging in sweat-producing activities like cycling, exercising, jogging or walking long distances. Avoiding excessive exposure to the sun will help to reduce the symptoms that appear in prickly heat rash.  

Washing the affected areas with a gentle soap and water, several times per day, often proves beneficial, but one should avoid rubbing or scratching the affected areas, as that will only increase the circulation in the affected area, as well as the intensity of the itchiness. Hot tubs or saunas tend to bring out prickly heat rash symptoms also. 

Wearing clothing that is made of cotton instead of other fabrics like polyesters and nylon, will reduce the symptoms of prickly heat rash because the skin is able to breathe. Clothing that is light in weight is preferable to heavy clothing, particularly in the summer time. Loose fitting clothing is preferable to tight fitting clothing. Prickly heat rash frequently occurs in parts of the body where there is tight fitting clothing being worn.

Avoiding over-dressing in the summer is a good rule of thumb, particularly with respect to infants and small children, as this tends to increase the body temperature, as well as the activity of the sweat glands.

With respect to topical applications, heavy ointments and creams may further occlude the sweat glands. Baby oil or light lotions are preferable. Avoiding perfumed creams, lotions and oils will reduce the degree of association with possible allergens. The use of cortisone creams or anti-histamines should be under the guidance of a health care professional.   

Ice packs are preferable to heat packs, in terms of resolving prickly heat rash.  

Keeping infants cool, clean and dry at all times, is important. They are particularly vulnerable to prickly heat rash from drooling, as well as the excess moisture retention associated with wet, plastic diapers or overheating from excessive clothing and blankets. Wearing cloth diapers instead of plastic ones may relieve some of the irritation. Placing infants or young children on cotton sheets or blankets, instead of those made out of polyester, nylon or plastic, may help to reduce the incidence of prickly heat rash.

In hospitals or nursing homes, patients confined to bed or wheelchairs for long periods of time, may need to be re-positioned every few hours and their pressure areas kept dry to prevent the build-up of excessive moisture, particularly when it is hot and humid. Talcum powder may prove to be beneficial, although an excessive build-up could create further problems.         

Obese patients, who have large folds of skin, tend to get prickly heat rash in those areas. Washing the affected folded areas of skin frequently and keeping them dry, is important. It may be possible to place cotton dressings between the folds of skin to separate them, if a breakdown of the skin tissue in these areas appears imminent.

For those affected by prickly heat rash, while it can be uncomfortable, it may not be as serious as it appears initially and it is treatable. What works for one person, may not be the best treatment for another, but there are many possible treatment options.    



3. Ibid.


4. Ibid.

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