Heat Rash
With warmer weather, we frequently see kids with heat rash. Young infants are particularly susceptible, and while the rash is neither concerning nor dangerous, it often bothers parents. So here are some tips.
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An overview
Heat rash, also called “prickly heat” or “Miliaria”, occurs as a result of sweating. Rather than evaporating, the sweat gets trapped, which leads to blockage and inflammation.
The rash is often seen in areas that see a lot of sweat such as skin folds (neck, armpits, or anywhere with friction). The most common forms are:
Miliaria crystallina: These look like little water droplets, about 1-2mm in diameter. They are superficial, don’t tend to get red, & rupture quite quickly (& painlessly).
Miliaria rubra. This form of Milia occurs at a deeper level, and often looks red/bumpy - it can even form blisters. It is more likely to be associated with inflammation than the superficial form and can be itchy or uncomfortable (hence “prickly”).
What causes it?
Anything that causes you to sweat can cause the rash:
hot, humid environments
intense physical activity
fever
too many layers of clothing in cooler weather
What can you do for it?
In most cases, you do not need to do anything for this type of rash. It is neither concerning nor contagious, but if your child is uncomfortable, some things you can try:
-Decrease sweating (move to a cooler environment, wash off sweat, wear LOOSE and breathable clothing that is non-occlusive, such as sweating)
Manage fever if it is the cause
avoid too many occlusive ointments or creams
cortisone, topical calamine or anhydrous lanolin can also soothe the prickly feeling, as can colloidal oatmeal
daily gentle exfoliation can be helpful for recurrent issues, with a textured washcloth, but no aggressive scrubbing because this may irritate skin further
it is rare to need medication for this type of rash, although sometimes we will prescribe a topical steroid if there is a large inflammatory component causing itching.
Prevention
Some children are more susceptible to heat rash, and it can be hard to prevent, because avoiding all situations where a child might sweat is impossible. Nevertheless, if your child already has some rash, focus on trying to keep them cool, avoid exercising in the heat, and wear loose breathable clothing. You can find more tips on protection from the sun and heat here.
When to call the pediatrician
This is not a comprehensive list. In general, always err on the side of calling your pediatrician if you have any concerns about your child. There is a lot to be said for a parent’s gut instinct, and I promise: your pediatrician would rather you called!
If your child has a rash that is not improving within a few days, or if they seem very uncomfortable or excessively itchy, call your pediatrician. Other concerning symptoms include:
Rash that is persistent beyond a few days, or recurrent
Signs of a skin infection (eg. increased redness, swelling, pus, warmth, pain, fever, chills)
Dehydration
Anything else tickling your spidey sense :)
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As the body becomes more efficient at cooling itself down, the problem of heat rash often improves.
As always, call your pediatrician if you’re concerned!
