A seven-year old presented with a two-day history of itchy and tender rash on the upper back. The boy had been previously well without any history of recent viral illness. Actually, apart from the rash, this boy was well.
When asked about any skin contact or clothing or play environment that was out of the ordinary, over the last few days, the father volunteered that the boy had worn a Superman costume for a few hours on Friday, when it was quite warm.
The boy, appropriately, had a large V-shaped rash on his upper back that looked akin to a dermatitis or folliculitis (image below). But the whole area was rather inflamed forming, as described, a large V.
The sweat under a non-breathable fabric and the mechanical chafing of the material against the skin had denuded the protective skin keratin and barrier oils allowing inflammation, and then bacterial penetration, of hair follicles and associated eccrine sweat glands.
The differential included:
Because of the inflammation and possible superinfection, I opted to start the boy on Keflex (cephalexin monohydrate) Suspension [250 mg/5 ml] 5 mL TID PO x 5 days and Sigmacort (hydrocortisone acetate) 1% Cream OD – BD TOP x 30g.
The boy should also appreciate a change to loose cotton clothing.
Miliaria, Dr Amanda Oakley – DermNet NZ, February 2018