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Miliaria pustulosa in Adult
Other Resources UpToDate PubMed

Miliaria pustulosa in Adult

Contributors: Grace J. Young BA, Susan Burgin MD
Other Resources UpToDate PubMed


Miliaria is caused by occlusion of the epidermal portion of eccrine sweat ducts. Miliaria pustulosa is a miliaria variant that occurs when pustules form in miliaria rubra. These pustules are usually sterile, but occasionally secondary infection with Staphylococcus aureus can occur.

The pathogenesis of miliaria is often related to conditions of high fever or high ambient temperatures with resulting hyperhidrosis, and it is more prevalent in hot, humid conditions and tropical climates. It is a benign disease characterized by intense pruritus and a stinging or "prickly"-type sensation. It is a common phenomenon postoperatively and in bedridden and febrile patients.

Other miliaria variants include the most superficial type, miliaria crystallina, miliaria rubra itself, and miliaria profunda (skin-colored papules with possible associated hypohidrosis or anhidrosis).

Both miliaria rubra and pustulosa have been reported to occur in newborns with type 1 pseudohypoaldosteronism. This typically resolves upon stabilization of disease.


L74.3 – Miliaria, unspecified

26988005 – Miliaria pustulosa

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Differential Diagnosis & Pitfalls

  • Other miliaria variants (Miliaria crystallina, Miliaria rubra, Miliaria profunda)
  • Candidiasis – Often has some pustules.
  • Folliculitis – Has follicular-based pustules.
  • Acne vulgaris – Can also be worsened by occlusion but usually lacks pruritus and is less acute.
  • Acute generalized exanthematous pustulosis (AGEP) – Is more diffuse with widespread pustules.
  • Varicella – Occasionally pustules are seen.
  • Transient acantholytic dermatosis – Also flares on the back of hospitalized patients with resulting very pruritic papules and erosions. Pustules are not a feature.

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Last Reviewed:07/06/2017
Last Updated:07/16/2019
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Miliaria pustulosa in Adult
A medical illustration showing key findings of Miliaria pustulosa : Fever, Flexural distribution, Intertriginous distribution, Neck, Trunk, Bedridden patient, Pustular rash
Copyright © 2024 VisualDx®. All rights reserved.