9/5/2016 DermatologicManifestationsofMiliariaWorkup:LaboratoryStudies,ImagingStudies,HistologicFindings

DermatologicManifestationsofMiliariaWorkup
Author:NikkiALevin,MD,PhDChiefEditor:DirkMElston,MDmore...

Updated:Feb09,2016

LaboratoryStudies
Miliariaisclinicallydistinctivetherefore,fewlaboratorytestsarenecessary.

Whenmiliariarubraoccursinpeoplewithdarkerskintypes,dermoscopyshowing
largewhiteglobuleswithsurroundingdarkerhalos,appearinglikeawhitebull's
eye,maybehelpfulinmakingthediagnosis. [24]

Inmiliariacrystallina,cytologicexaminationofthevesicularcontentsfailstoreveal
inflammatorycellsormultinucleatedgiantcells(aswouldbeexpectedinherpes
vesicles).

Inmiliariapustulosa,cytologicexaminationofthepustularcontentsreveals
inflammatorycells.Unlikeerythematoxicumneonatorum,eosinophilsarenot
prominent.Gramstainingmayrevealgrampositivecocci(eg,staphylococci).

ImagingStudies
Highdefinitionopticalcoherencetomographyhasbeenusedtohelpestablishthe
diagnosisofmiliaria. [25]

HistologicFindings
Inmiliariacrystallina,intracornealorsubcornealvesiclescommunicatewitheccrine
sweatducts,withoutsurroundinginflammatorycells.Obstructionoftheeccrineduct
maybeobservedinthestratumcorneum.

Inmiliariarubra,spongiosisandspongioticvesiclesareobservedinthestratum
malpighian,inassociationwitheccrinesweatducts.Periductalinflammationis
present.

Inearlylesionsinmiliariaprofunda,apredominantlylymphocyticperiductalinfiltrate
ispresentinthepapillarydermisandlowerepidermis.APASpositivediastase
resistanteosinophiliccastmaybeseenintheductallumen.Inlaterlesions,
inflammatorycellsmaybepresentlowerinthedermis,andlymphocytesmayenter
theeccrineduct.Spongiosisofthesurroundingepidermisandparakeratotic
hyperkeratosisoftheacrosyringiummaybeobserved.

Inthegranulomatousgiantcentrifugalvariantofmiliariaprofunda,biopsiesshow
mildspongiosisandacanthosis,hypergranulosis,andhyperplasiaofthe
acrosyringia,theeccrineducts,andinfundibula,withinvaginationbykeratinplugs.
Thereisagranulomatousinflammatoryinfiltratewithinthedermis,consistingof
lymphocytesandforeignbodygiantcellswithafewneutrophilscenteredaroundthe
rupturedstraightportionoftheeccrineduct. [12]

Treatment&Management

ContributorInformationandDisclosures
Author
NikkiALevin,MD,PhDAssociateProfessorofMedicine,DivisionofDermatology,UniversityofMassachusetts
MedicalSchool

NikkiALevin,MD,PhDisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,American
AcademyofDermatology,PhiBetaKappa,SigmaXi

Disclosure:Nothingtodisclose.

SpecialtyEditorBoard
MichaelJWells,MD,FAADAssociateProfessor,DepartmentofDermatology,TexasTechUniversityHealth
SciencesCenter,PaulLFosterSchoolofMedicine

MichaelJWells,MD,FAADisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,American
AcademyofDermatology,AmericanMedicalAssociation,TexasMedicalAssociation

Disclosure:Nothingtodisclose.

RosalieElenitsas,MDHermanBeermanProfessorofDermatology,UniversityofPennsylvaniaSchoolof
MedicineDirector,PennCutaneousPathologyServices,DepartmentofDermatology,UniversityofPennsylvania
HealthSystem

RosalieElenitsas,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofDermatology,
AmericanMedicalAssociation,AmericanSocietyofDermatopathology,PennsylvaniaAcademyofDermatology

Disclosure:ReceivedroyaltyfromLippincottWilliamsWilkinsfortextbookeditor.

ChiefEditor
DirkMElston,MDProfessorandChairman,DepartmentofDermatologyandDermatologicSurgery,Medical
UniversityofSouthCarolinaCollegeofMedicine

DirkMElston,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofDermatology

http://emedicine.medscape.com/article/1070840workup 1/3
9/5/2016 DermatologicManifestationsofMiliariaWorkup:LaboratoryStudies,ImagingStudies,HistologicFindings

Disclosure:Nothingtodisclose.

AdditionalContributors
JanetFairley,MDProfessorandHead,DepartmentofDermatology,UniversityofIowa,RoyJandLucilleA
CarverCollegeofMedicine

JanetFairley,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofDermatology,American
FederationforMedicalResearch,SocietyforInvestigativeDermatology

Disclosure:Nothingtodisclose.

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