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Rash, Heat

For further information, see CMDT Part 6-30: Miliaria (Heat Rash)

Key Features

  • Burning

  • Itching

  • Superficial aggregated small vesicles, papules, or pustules on covered areas of the skin, usually the trunk

  • More common in hot, moist climates

Clinical Findings

  • Burning and itching

  • Lesions consist of small, superficial, red, thin-walled, discrete but closely aggregated vesicles (miliaria crystallina), papules (miliaria rubra), or vesicopustules or pustules (miliaria pustulosa)

  • Differential diagnosis

    • Folliculitis

    • Drug eruption

Diagnosis

  • Clinical

Treatment

  • See Table 6–2

  • Triamcinolone acetonide, 0.1% in Sarna lotion or mid-potency corticosteroid in a lotion or cream applied two to four times daily

  • Secondary infections (superficial pyoderma) are treated with appropriate antistaphylococcal antibiotics

  • Anticholinergic drugs may be helpful in severe cases, eg, glycopyrrolate, 1 mg twice daily orally

Table 6–2.Useful topical dermatologic therapeutic agents.1
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Table 6–2. Useful topical dermatologic therapeutic agents.1
Agent Formulations, Strengths, and Prices2 Frequency of Application Potency Class Common Indications Comments
Corticosteroids (Listed in Order of Increasing Potency)
Hydrocortisone acetate

Cream 1%: $5.59/28.4 g

Ointment 1%: $3.91/40 g

Solution 1%: $7.34/44 mL

 Twice daily Low

Seborrheic dermatitis

Pruritus ani

Intertrigo

Not the same as valerate or hydrocortisone butyrate

Not for poison oak OTC lotion (Aquanil HC), OTC solution (Scalpicin)
  Cream 2.5%: $11.01/30 g     As for 1% hydrocortisone

Perhaps better for pruritus ani

Not clearly better than 1%

More expensive

Not OTC
Alclometasone dipropionate (Aclovate)

Cream 0.05%: $48.08/15 g

Ointment 0.05%: $20.00/15 g

 Twice daily Low As for hydrocortisone

More efficacious than hydrocortisone

Perhaps causes less atrophy
Desonide

Cream 0.05%: $21.60/15 g

Ointment 0.05%: $23.25/15 g

Lotion 0.05%: $222.92/60 mL

 Twice daily Low

As for hydrocortisone

For lesions on face or body folds resistant to hydrocortisone

More efficacious than hydrocortisone

Can cause rosacea or atrophy

Not fluorinated
Clocortolone (Cloderm) Cream 0.1%: $322.47/45 g Three times daily Medium

Contact dermatitis

Atopic dermatitis

 Does not cross-react with other corticosteroids chemically and can be used in patients allergic to other corticosteroids
Prednicarbate (Dermatop)

Emollient cream 0.1%: $137.10/60 g

Ointment 0.1%: $30.00/15 g

 Twice daily Medium As for triamcinolone

May cause less atrophy

No generic formulations

Preservative-free
Triamcinolone acetonide

Cream 0.1%: $3.89/15 g

Ointment 0.1%: $5.57/15 g

Lotion 0.1%: $42.42/60 mL

 Twice daily Medium

Eczema on extensor areas

Used for psoriasis with tar

Seborrheic dermatitis and psoriasis on scalp

Caution in body folds, face

Economical in 0.5-lb and 1-lb sizes for treatment of large body surfaces

Economical as solution for scalp
 

Cream 0.025%: $15 g

Ointment 0.025%: $10.40/80 g

 Twice daily Medium As for 0.1% strength Possibly less efficacy and few advantages over 0.1% formulation
Fluocinolone acetonide

Cream 0.025%: $33.77/15 g

Ointment 0.025%: $33.77/15 g

 Twice daily Medium As for triamcinolone  
  Solution 0.01%: $180.00/60 mL Twice daily Medium As for triamcinolone  
Mometasone ...

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