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A7 year old male child was admitted to our hospital during the summer with staphylococcal scalded skin syndrome (SSSS). After five days of appropriate treatment, he was to be discharged. Unexpectedly, while he was playing in the ward, his skin suddenly erupted with crops of clear, 2–10 mm, waterdrop-like vesicles as we watched. The parents and nursing staff became anxious as the vesicles were extremely fragile and broke with the slightest touch. They also involved previously unblistered skin. This seemed typical of miliaria crystallina except for the size.2 After reassurance, he was sent home. The rash lasted for 18 hours and resolved spontaneously by peeling.
Miliaria crystallina is a transient occlusive sweat gland disorder resulting in the leakage and retention of sweat into the epidermis.1 It is characterised by diffuse eruption of extremely fragile, asymptomatic, epidermal, 1–3 mm size, waterdrop-like vesicles which appear in crops on a non-inflammatory base.2 It is seen commonly during the neonatal period and rarely, presents congenitally.1 In children and adults, it can be seen in febrile illnesses due to increased sweating and also following the use of drugs including bethanechol3 and isotretinoin.4 Miliaria has been hypothesised to be due to sweat duct disruption and occurs when a potential space develops between the affected epidermal cells and the new proliferating cells beneath them.5
In our patient, we postulate that staphylococcal toxins weakened the epidermis, creating a potential space. His increased activity while playing led to pooling of sweat in this space which manifested as miliaria crystallina. We would like to remind paediatricians of the occurrence of this self limiting, harmless, but sometimes alarming disorder in any fever, although in SSSS there is a particular reason for the spread of the lesions.