Milliaria cristalina in the course of severe hypothyroidism: a case report

Abstract

Miliaria represent a group of pathologies, characterized by heterogeneous skin eruptions, determined by the blocking of sweat ducts, resulting in the leakage of eccrine sweat into the epidermis or dermis. We note 3 basic types of miliaria, depending on the depth at which the obstruction of the sweat duct occurred: miliaria crystallina, rubra and profunda. In miliaria cristallina, the ductal obstruction is most superficial, occurring in the stratum corneum. Clinically, this type of miliaria is characterised by tiny, fragile, clear vesicles. The following factors can cause miliaria crystallina: immaturity of the eccrine ducts, occlusive skin covering (patches), synthetic material clothing, hot and humid conditions, lack of acclimatization, high fever, type 1 pseudohypoaldosteronism, UV rays. Also, in the medical literature, several cases of the appearance of miliaria crystallina on the background of severe hypothyroidism in children are described. Thyroid hormones are important regulators of epidermal homeostasis. In cases of hypothyroidism, the skin becomes rough and covered with fine scales and the effect on the sweat glands is by reducing seating and causing xerosis. Histological examination will reveal thinning of the epidermis and hyperkeratosis. Objective To examine the cutaneous presentation of miliaria crystallina - a dermatosis associated with thyroid dysfunction. Case report We present a case of crystalline miliaria in a 25-year-old patient with Down syndrome, admitted to the endocrinology department due to decompensated hypothyroidism, associated with severe myxedema and polyserositis: cardiac effusion, pleurisy and ascites. On the 10th day of treatment in the clinic, eruptions appeared in the form of superficial, semi-transparent vesicles, 1-2 mm in diameter, similar to „raindrops”, non-pruritic. The elements were mainly disseminated in the region of the trunk, neck, abdomen and less in the thighs, without inflammatory signs of the adjacent teguments, the patient being afebrile. The rashes resolved spontaneously on the 3rd day after the onset, without specific medical intervention, with the restoration of the initial appearance of the involved integuments. Discussions The appearance of miliaria crystallina after 10 days of treatment can be interpreted as a consequence of long-term hormonal deficiency, but also as a consequence of substitution therapy and the reappearance of the sweat-stimulating effect of thyroid hormones after a long period of decompensated hypothyroidism. Cases of miliaria due to hypothyroidism in children are described in the literature, but this is practically not described in adults with this pathology. Conclusions The deficiency of thyroid hormones that are directly involved in epidermal homeostasis can cause skin manifestations, such as miliaria crystallina in our case, through direct or indirect actions on the skin. Miliaria crystallina is a rare, benign, self-limiting pathology that resolves itself without specific medical intervention.