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LETTER TO EDITOR

Congenital miliaria crystallina following

maternal febrile illness
Sir,
A term male, appropriate for gestational age baby was
born to a 22yearold G2A1 mother by spontaneous
vaginal delivery. The baby was 3.4kg, cried
immediately after birth and had Apgar scores of 8 and
9 at 1 and 5min, respectively. The neonate was found
to have multiple, tiny, eruptions with clear fluid all
over the body especially in the trunk and extremities.
Antenatal history revealed that mother was admitted
with fever at 38+4weeks, 1week before the date of
delivery. She was diagnosed to have lower respiratory
infection and received oral antibiotics, antipyretics,
and salbutamol nebulization for 3days following
which the fever subsided.
Examination of newborn revealed multiple tiny clear
vesicular eruptions that closely mimicked sprinkled
water droplets[Figures1 and 2]. The lesions were
about 1-3mm size, seen predominantly over the
neck, upper chest, back, and both upper limbs. The
lesions were closely placed(in crops) with a shiny
surface. The underlying skin was normal, without
any evidence of erythema or induration. The lesions
ruptured easily but healed without leaving any marks.
The baby was otherwise active and feeding well. Vitals
and systemic examination were normal. Adiagnosis of
miliaria crystallina(MC) was considered based on the
morphology of the lesions. No new lesions appeared
after 1stday. The lesions disappeared spontaneously
within the first 4days of life.
Miliaria crystallina is a transient, selflimiting,
superficial obstruction of eccrine sweat ducts resulting
in extravasation of sweat into epidermis. MC may
present in the neonatal period but congenital
occurrence is extremely rare.[1] This benign selflimiting
condition is often triggered by hot and humid climate.
The lesions contain clear watery fluid, thinroofed, and
without any inflammation. The lesions are generalized
involving face, trunk and extremities but palms, soles,
and mucosa are usually spared.[2] The risk factors for
developing congenital MC are maternal febrile illness
prior to delivery, moist occlusive environment of
amniotic fluid, and vernix caseosa.[1] The presence of
maternal fever was the trigger for congenital MC lesions
150

Figure 1: Picture taken immediately after birth (note the moist and fleshy
umbilical cord stump) showing distribution of vesicles involving the trunk
and the upper extremities

Figure 2: Tiny, clear, vesicular eruption mimicking sprinkled water droplets

in upper extremity

in our case. Aspiration cytology reveals clear serous

fluid with no inflammatory cells or multinucleated
giant cells. No therapy is required as this condition is
selflimiting and resolves without any complications.
Thirunavukkarasu Arun Babu, Vijayasankar
Vijayadevagaran, Vijayan Sharmila1
Departments of Pediatrics and 1Obstetrics and
Gynaecology, Indira Gandhi Medical College and
Research Institute, Puducherry, India

Indian Journal of Paediatric Dermatology | Vol 15 | Issue 3 | September-December 2014

[Downloaded free from http://www.ijpd.in on Tuesday, May 03, 2016, IP: 114.121.134.5]
Letter to Editor
ADDRESS FOR CORRESPONDENCE
Dr.Thirunavukkarasu Arun Babu,
Associate Professor of Pediatrics, Indira Gandhi Medical
College and Research, Institute, Puducherry, India.
Email:babuarun@yahoo.com

In: HarperJ, OranjeAP, ProseNS, editors. Textbook of Pediatric

Dermatology. Oxford: Blackwell; 2006. p.635.

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REFERENCES
1. BabuTA, SharmilaV. Congenital miliaria crystallina in a
term neonate born to a mother with chorioamnionitis. Pediatr
Dermatol 2012;29:3067.

Website:
www.ijpd.in
DOI:
10.4103/2319-7250.143679

2. TaiebA, BoraleviF. Common transient neonatal dermatoses.

Indian Journal of Paediatric Dermatology | Vol 15 | Issue 3 | September-December 2014

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