The pathogenesis of miliaria rubra.

Abstract

Anhidrosis was induced in volunteers by covering the skin with an impermeable plastic film. The degree of sweat suppression and miliaria after a thermal stimulus was directly proportional to the increase in the density of resident aerobic bacteria, notably cocci. No anhidrosis resulted when antibacterial substances were used to prevent the expansion of the microflora. Histological study showed a PAS-positive diastase resistant amorphous mass deep within the acrosyringium after 2 days of occlusion, accompanied by a periductal dermal infiltration of leukocytes. After another 2 days the duct became clogged by an amalgam of degenerating leukocytes. This impaction sloughed after about 3 weeks as a result of epidermal renewal. Colonies of bacteria were never found within the ducts. It is postulated that cocci secrete a toxin which injures luminal cells and precipitates a cast within the lumen. Infiltration by leukocytes creates an impaction which completely obstructs the passage of sweat for several weeks.

Giant Centrifugal Miliaria Profunda

“…The condition in our patient closely resembled that produced experimentally by Holzie and Kligman (1). Severai days of occiusion with impermeable tape preceded the development of most of the lesions.…”

“…Dobson et al (6) thought it had its origin in the secretory cells of the sweat coil, while Holzle and Kligman (1) considered it to derive from the cytoplasm of sweat duct iuminal cells, whose cell membranes have been rendered more permeable by toxins from the bacteria that are significantly increased in numbers on skin whose stratum corneum is overhydrated by sweating. After four days of occlusion in Holzle and Kligman's study (1), the amorphous material was intermingled with inflammatory cells, which subsequently degenerated, forming a firm plug that was still evident one week after the occlusion had ceased. Clinically, miliaria rubra was evident due to extravasation of sweat through the damaged acrosyringium into the epidermis.…”

“…A PAS-positive material had been demonstrated in the ducts in some cases of experimentally induced miliaria (6) and in anhidrotic lesions of psoriasis and other chronic dermatoses (8). The studies of Holzle and Kligman (1) suggested that this material represented the primary obstruction. These workers induced anhidrosis by covering the skin with an impermeable plastic dressing.…”

Patients presenting with miliaria while wearing flame resistant clothing in high ambient temperatures: a case series

“…Although Kandahar has relatively low humidity, it is known that occlusion of skin due to clothing can further contribute to pooling of sweat on the skin surface and overhydration of the stratum corneum (outermost layer of the epidermis skin) causing blockage of sweat ducts. Bacteria occurring naturally on the skin, such as Staphylococcus epidermidis and Staphylococcus aureus , are also thought to play a role in the pathogenesis of miliaria [4]. Furthermore, an individual diagnosed as having miliaria rubra should be monitored for risk of heat illness, as it is a sign of heat stress.…”

Studies on sweating and bacterial ecology in Juvenile Plantar Dermatosis

“…them with healthy controls for the following two parameters of sweating: (i) The spatial distribution of active sweat glands over the big toe in relation to the severity of the disease; and (2) By using a standardized 'usage' technique (Keech & Hole, 1970), we have attempted to detect a difference in sweat retention between affected children and normal healthy controls. Holze and Kligman (1978) suggested that the anhidrosis of experimental miliaria induced by plastic film occlusion of the skin may be due to bacterial overgrowth. We therefore investigated the bacterial flora of the feet of children with JPD, and compared this with normal childrens' feet to determine whether a similar mechanism could be involved in JPD in producing the anhidrosis observed in the affected areas (Shrank, 1979)-…”