Diagnosis and Management of Miliaria Rubra and Folliculitis

Clinical Assessment and Differential Diagnoses

The distribution pattern of both miliaria rubra and folliculitis commonly affects intertriginous areas, such as the axillae and chest, where occlusion and sweating occur, as noted by the American Academy of Dermatology 1
Critical differential diagnoses to exclude include scabies, which can be identified by looking for burrows, inguinal/genital involvement, and palmoplantar vesicles in infants, according to the American Academy of Dermatology 2
Eczematous dermatitis should also be considered, typically characterized by oozing, crusting, and less discrete pustules, as reported by the American Academy of Dermatology 1

For bacterial folliculitis, oral antibiotics such as flucloxacillin for Staphylococcus aureus or erythromycin for penicillin allergy may be indicated if secondary bacterial infection is evident, as recommended by the American Academy of Dermatology 3
Antiseptic washes, such as chlorhexidine or benzoyl peroxide, can help reduce bacterial colonization in bacterial folliculitis, according to the American Academy of Dermatology 3
For miliaria rubra, treatment focuses on reducing heat and moisture, with recommendations including cool compresses, keeping affected areas dry and cool, and avoiding occlusive clothing, as suggested by the American Academy of Dermatology 4
Mild topical corticosteroids, such as hydrocortisone 1%, may be used for pruritus in miliaria rubra if needed, applied twice daily for 3-5 days, as recommended by the American Academy of Dermatology 4, 5

Avoiding irritants, such as stopping the use of soaps and detergents, and using dispersible cream as a soap substitute can help manage symptoms, as recommended by the American Academy of Dermatology 4, 3
Emollients, such as non-greasy moisturizers, can be applied after bathing to maintain the skin barrier, according to the American Academy of Dermatology 4
Potent topical corticosteroids should not be used in intertriginous areas due to increased absorption and risk of skin atrophy, as warned by the American Academy of Dermatology 1, 5
Greasy products should be avoided as they can inhibit wound exudate absorption and promote superinfection, as cautioned by the American Academy of Dermatology 4