Clin Exp Nephrol (2014) 18:831832

DOI 10.1007/s10157-013-0912-7

IMAGES IN NEPHROLOGY

Hypernatremia-related miliaria crystallina

Chia-Ter Chao

Received: 30 October 2013 / Accepted: 9 November 2013 / Published online: 22 November 2013
Japanese Society of Nephrology 2013

Keywords

Miliaria
Vesicle
Sweat gland

A 40-year-old male with a history of surgically treated

craniopharyngioma was admitted due to a falling injury.
No intracranial bleeding was found. However, hypernatremia (180 meq/L) and polyuria (daily urine 6,000 mL)
were noted. The patient reported no episode of obvious
excessive sweating, but he did have thirst sensation intermittently. He did not receive any adrenergic/anti-adrenergic or cholinergic medications before admission. Physical
examination showed dry mucosal surface and mild tachycardia (112 beats/min), without hyperthermia or fever.
Central diabetes insipidus related to recurrent craniopharyngioma was diagnosed. In addition, crops of clear and
superficial vesicles measuring 12 mm in diameter were
also noted over his neck and precordial areas (Fig. 1).
These vesicles were confluent without surrounding erythema, wiped off easily and showed branny desquamation.
Miliaria crystallina was suspected. The vesicles resolved
spontaneously several days later, along with resolution of
the hypernatremia (Fig. 2).
Miliaria crystallina is a self-limited transient occlusive
sweat gland disorder, leading to leakage and retention of
sweat into the epidermis. Environmental heat, humidity

C.-T. Chao (&)

Division of Nephrology, Department of Internal Medicine,
National Taiwan University Hospital Jin-Shan branch, No. 51,
Nanshi, Jinshan District, New Taipei City 208, Taiwan
e-mail: b88401084@gmail.com

Fig. 1 Photograph showing multiple pin-head to pea-sized vesicles

with a clear background over the neck and precordium

Fig. 2 Complete resolution of cutaneous vesicles several days later

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Clin Exp Nephrol (2014) 18:831832

and adrenergic/cholinergic drugs are common precipitants

[1]. High sodium in sweat from hypernatremia might assist
by inducing eccrine ductal damage, leading to its rare
occurrence [2].
Conflict of interest
interest.

123

The authors have no financial conflict of

References
1. Haas N, Martens F, Henz BM. Miliaria crystallina in an intensive
care setting. Clin Exp Dermatol. 2004;29:324.
2. Engur D, Turkmen MK, Savk E. Widespread miliaria crystallina in
a newborn with hypernatremic dehydration. Pediatr Dermatol.
2012;. doi:10.1111/pde.12055.

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