Cooling by regulation of environmental temperatures and removing excessive clothing can dramatically reduce miliaria rubra. Antipyretics can relieve the symptoms in febrile patients. Topical agents are not recommended because they may exacerbate the skin eruptions.4
Papular urticaria predominantly affects children and is caused by allergic hypersensitivity to insect bites.6 The skin lesions are intensely pruritic and are initially characterized by multiple small erythematous wheals and later progress to pruritic brownish papules.3 Some lesions may have a central punctum. The patient’s age and a history of symmetrically distributed lesions, hypersensitivity, and exposure to animals or insects can help diagnose papular urticaria.6 Lesions are typically observed on exposed areas, can persist for days or weeks, and usually occur in the summer.7
Management of papular urticaria includes the 3 Ps:
- Protection. Children should wear protective clothing for outdoor play and use insect repellent.
- Pruritus control. Topical high-potency steroids and antihistamines may help with individual lesions, but may be ineffective when the inflammatory process extends to the dermis and the fat.
- Patience. Although there is a chance that papular urticaria will be persistent and recurrent, it typically improves with time.6
Lichen nitidus is rare and when it does occur, it typically develops in children.8 Some lesions subside spontaneously, but others may persist for as long as several years.8
Lichen nitidus is clinically manifested as asymptomatic, discrete, flesh-colored, shiny, pinpoint-to-pinhead-sized papules; these papules are sharply demarcated and have fine scales. The most commonly affected sites are the genitalia, chest, abdomen, and upper extremities.8-10 The isomorphic condition called Koebner phenomenon is observed in most cases.3
Lichen nitidus is diagnosed on the basis of clinical presentation. Biopsy is indicated only when atypical morphology and distribution are observed. Histologically, the pathognomonic features of lichen nitidus include focal granulomas containing lymphohistiocytic cells in the papillary dermis.
Lichen nitidus usually regresses spontaneously and most patients do not require intervention; treatment is required only when the patient complains of pruritus or cosmetically undesirable effects.5 Topical glucocorticoid treatment may provide good results in such cases.8
Molluscum contagiosum is caused by poxvirus infection and generally affects young children. It is asymptomatic and presents with small pearly white or pink round/oval papules that may have umbilication. The papules are often 2 to 5 mm in diameter, but can be as large as 3 cm (a giant molluscum). Most papules appear in intertriginous sites such as the groin, axilla, and popliteal fossa.