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Treating Heat Rash
Q: I have a six-year-old daughter who is bothered by heat rash. She has had this problem on and off since infancy. She complains that the bumps itch. She gets them on her face and in the middle of her back. In the summer I try to keep powder on her, but this doesn't seem to help. I've tried hydrocortisone cream (1 percent), which seems to give some relief. What else can I try? Why do these small pimples keep coming back?
A: Heat rash or prickly heat happens because sweat is retained in the blocked ducts and pores of a type of sweat gland in our skin. These blocked pores don't always allow sweat to leak out, so at times it can leak deeper into the skin, causing an inflammatory reaction. This happens most commonly when these glands are working their hardest -- in hot, humid weather, or when someone has a fever. As with your daughter, it is frequently noted in infancy. It has even been reported that infants who are warmly dressed indoors may develop this in the winter.
There is no magic treatment other than cooling off the patient. Try to regulate the temperature in her environment, keep her in minimal amounts of loose fitting clothing (so as not to be be overdressed), and use the medicines your child's doctor recommends to bring down the body's temperature if she has a fever. Cool baths may help the itch. Steroid creams and powder usually don't help, and sometimes can even worsen the situation. Avoiding anything that can further block the sweat glands is appropriate.
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Henry Bernstein, M.D., is currently the associate chief of the Division of General Pediatrics and director of Primary Care at Children's Hospital, Boston. He also has an academic appointment at Harvard Medical School.