How to treat heat rash

Q: I have a heat rash from the hot weather we’ve been having recently. What’s the best way to get rid of it?

In her seventies, Donna developed redness and itching in her groin area during a recent heat wave. She tried applying Gold Bond® powder but it didn’t seem to help.

She came into our pharmacy, asking what else she could do for it.  

Heat rash, also called prickly heat or miliaria can happen to anyone with active sweat glands. It’s estimated that at least 40% of infants will get a heat rash at one point. Heat rash also afflicts people who are physically active and sweating in the summer heat doing strenuous physical work, performing sports or exercise, even gardening.

Prickly heat or heat rash is caused by clogged sweat glands. When sweat builds up under your skin it can become trapped, causing your pores to swell and rupture.

This creates small red, raised lesions that burn or itch that cluster in small clumps or spread out over larger areas. Outbreaks can occur anywhere you tend to sweat: your armpits, chest, upper back, belly, and groin. If the blockage is severe enough it creates inflammation, pustules, or a yeast infection.

Heat rash or prickly heat can also happen to people who have been treating their dry itchy skin with heavy creams or ointments which work great during the winter months but during a hot, sweaty summer can plug up their hard-working sweat glands.

The first key to relieving the itching and burning of prickly heat to keep your skin dry. One of the best ways to do that is by maximizing airflow to the skin to discourage excess sweating. Wearing loose, lightweight clothing during hot weather is critically important, along with using fans to improve air flow. Fevers can cause profuse sweating and should be treated with appropriate doses of acetaminophen to decrease excess moisture next to the skin.

The second key to treating heat rash is to avoiding applying oils, heavy creams or ointments to your overworked sweat glands in areas that perspire heavily like under your arms, your chest, around your groin, behind your knees and under any folds of skin.

The third key to treating prickly heat is to avoid applying either medicated or plain powders to red, broken or irritated skin. Powders can clog inflamed pores and sweat glands, so it’s best to stay away from them entirely until your skin has calmed down.

Heat rash can cause intense itching and an almost uncontrollable urge to scratch. Scratching feels good but only provides short-term relief and instead triggers more inflammation and itching. Instead, apply cloths dampened with cool water along with a non-prescription steroid cream containing 1% hydrocortisone. Hydrocortisone 1% cream is safe to use on small areas of broken skin or larger areas of unbroken skin in adults but avoid putting it on broken skin of children or infants.

Be sure to avoid using hydrocortisone ointment because ointments can block your sweat glands. If these strategies don’t help the itching and irritation of heat rash, contact your doctor as there are other conditions that may look like heat rash at first but need to be treated differently.

Here are 6 Tips for Treating Prickly Heat or Heat Rash:

1. Increase airflow to the affected area.

Wear lightweight, loose clothing or no clothing at all. House fans can help circulate air over your skin.

2. Lukewarm sponge baths increase evaporation, helping to cool and dry the skin.

Avoid hot water for showers or baths, which can increase inflammation. Adding oatmeal or a similar product like Aveeno® can also help soothe irritated skin.

3. Avoid using skin powders like Gold Bond®, especially on broken skin.

Because powder can clog your sweat glands, avoid them until the acute symptoms of redness and itching subside.

4. Avoid using topical Benadryl® cream or spray and use 1% hydrocortisone cream instead.

Although Benadryl® (diphenhydramine) capsules and liquid can help relieve itching, diphenhydramine cream or topical spray should be avoided.  Benadryl® can be absorbed into the bloodstream from areas of broken skin, and when combined with the capsules or liquid can cause drowsiness and confusion.

5. Avoid using heavy creams and ointments that can trap moisture.

Keep your armpits, groin, and chest plus any skin folds as dry as possible. Tucking a light cloth like a pillowcase between skin folds and changing it frequently absorbs perspiration.

6. Cool it before you use it.
For additional soothing power, refrigerate your hydrocortisone cream or aloe vera gel before applying it.

Dr. Louise Achey, Doctor of Pharmacy is a 40-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Your questions and comments are always welcome at ®2019 Louise Ache

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