Friday - - Beauty -

Q My wife and I have suf­fered from heat rash al­most ev­ery sum­mer for the last sev­eral years. We both are slightly over­weight, and these rashes be­come more se­vere in ar­eas of our body folds. They are ex­tremely itchy. Please sug­gest any treat­ment.

AThe usual heat rash, com­monly called prickly heat, is med­i­cally known as Mil­iaria Rubra. It ap­pears due to the block­age of sweat gland ducts at times of sweat over­pro­duc­tion in re­sponse to ex­po­sure to ex­ces­sive heat.

Sweat glands are thermo-reg­u­lated, that is, an in­crease in en­vi­ron­men­tal tem­per­a­ture will cause an in­creased stim­u­la­tion of the sweat glands mak­ing them over­ac­tive and pro­duce ex­ces­sive sweat.

This can be ob­served dur­ing the hot sum­mer or in peo­ple en­gaged in cer­tain in­dus­trial heat-in­duc­ing en­vi­ron­ments.

The ker­atin fil­a­ments, which are the pri­mary struc­tural com­po­nents of sweat gland ducts, get par­tially dis­lodged and clut­tered, block­ing the pas­sage of sweat. This re­sults in the for­ma­tion of in­flamed, se­verely itchy, papu­lar skin erup­tions known as ‘prickly heat’.

These erup­tions can get worse in peo­ple wear­ing tight dresses made of close-knit fab­rics.

In over­weight or obese peo­ple, the same ef­fect can be seen in their body folds.

The skin in the body folds can get acutely in­flamed with­out any over­ly­ing papu­lar erup­tions, a con­di­tion called in­ter­trigo. This is mostly due to fric­tional der­mati­tis of the in­volved ar­eas – where two skin sur­faces re­main con­tin­u­ously rub­bing against each other.

The most im­por­tant step in the treat­ment of prickly heat is to avoid sit­u­a­tions where you are ex­posed to heat and ex­ces­sive sweat­ing.

An­other im­por­tant step is avoid­ing the use of tight cloth­ing made of thick fab­rics such as denim and very coarse thick cot­tons. Thin, loos­e­fit­ting cot­ton cloth­ing will aid a faster re­cov­ery.

Skin erup­tions can be treated by fre­quent ap­pli­ca­tion of cold com­presses on af­fected ar­eas and us­ing zinc ox­ide (calamine) lo­tion for re­lief from itch­ing. This is the most com­mon re­me­dial ac­tion in mild cases.

In more se­vere cases, ap­pli­ca­tion of po­tent top­i­cal steroidal creams such as clo­be­ta­sol pro­pi­onate have been found to be quite ben­e­fi­cial.

In a few cases, suf­fer­ers can be seen with in­ter­spersed pus­tu­lar erup­tions – a re­sult of the ac­tiv­ity of the bac­te­ria Staphy­lo­coc­cus epi­der­midis.

In these cases, a top­i­cal an­ti­sep­tic wash can be added to the on­go­ing treat­ment.

How­ever, in re­sis­tant cases a short course of oral an­tibi­otics may be­come nec­es­sary. To­tal re­gres­sion of prickly heat can take a cou­ple of weeks, so do not panic and be­gin mul­ti­ple hap­haz­ardly se­lected treat­ments.

DR IKRAMULLAH AL NASIR is a Dubai-based der­ma­tol­o­gist

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