Sweat dermatitis

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Sweat dermatitis is a peculiar kind of irritant inflammatory dermatoses occurring due to prolonged exposure of retained sweat over the skin. It is commonly seen in hot and dry climates like tropics during summer months due to thermal stress. Typically, parchment paper or cellophane paper like scaling is seen over occluded areas of back, shoulder, and other areas. Here we have reported a varied presentation of sweat dermatitis in the form of its coexistence with miliaria rubra (impending to thermal burn). Further we have also observed co existing pityriasis versicolor and sweat dermatitis where the former has prevented the development of latter. Till date there is very little discussion on this condition, so we have tried to provide a concise review about sweat dermatitis along with its classical to atypical presentation with special emphasis on dermoscopy. A 6-month-old baby boy was brought to the Dermatology OPD by his mother for brown colored scaly lesions over his back. The rash began as patchy erythema 4 days back which evolved to present state. Mother gave history of wrapping the child completely with multiple layers of clothing to prevent infections. There was no history of atopy. On cutaneous examination there was brownish “parchment”-like, shiny skin over the entire upper back and shoulder region. Patchy exfoliation was also present. A 40-year-old male laborer presented to dermatology OPD with severe itching and burning sensation along with exfoliation of skin over back for 1 day. He reported history of developing these lesions overnight after sleeping bare bodied over the hot cement flooring of his home. There was no history of any similar rash in the past. On examination there were well-demarcated maculopapular rashes over entire back, which was beef red in color and studded with multiple pinpoint vesicular eruptions mainly towards the outer/lateral aspect. Interspersed between these dew drops like lesions, there were patchy, irregular areas of superficial necrosis. Exfoliation was also present in few areas. A small elliptical strip of normal skin was preserved in the lower mid back where there was pronounced grooving in lumbar spinal region. Clinical diagnosis of acute irritant reaction to sweat with miliaria rubra was made. Routine hematological and biochemical investigations were normal. On Dermoscopy (Handheld contact dermoscope: DermLite DL3 gen. Polarized view with magnification 20×) there was diffuse background erythema interspersed with yellowish white lacunar areas (dew drop like lesions) probably corresponding to the obstructed sweat gland duct opening. Scattered dark brown colored irregular stellate areas in regions with clinical necrosis were also observed giving a pseudo reticulate appearance along with patchy scaling. This dermocopic finding could be described as “Starry sky” appearance. Typical white bulls eye sign of miliaria rubra with white globules consisted of a central white area surrounded by a darker halo forming a dot within a dot could also be appreciated. A 23-year-old male working in a corporate office presented with itching and scaling over the back since 6 days. On probing patient gave the history of traveling for 10 hours in a non-air-conditioned bus 7 days back. Cutaneous examination revealed two different types of lesions over the back and shoulders. There were areas of hyper pigmented coarse cigarette paper like scaling present extensively over entire back along with few well demarcated clear areas or apparent islands of normal skin in between. On dermoscopy (non polarized view) from the pigmented area, there were increased cutaneous markings along with deep brown pigmentary changes with superimposed brownish scales seen at few places. Journal of Dermatitis is using Editorial Tracking System for quality in review process. Editorial Tracking is an online manuscript submission, review and tracking systems used by most of the best open access journals. Review processing is performed by the editorial board members of journal or outside experts; at least two independent reviewers approval followed by editor's approval is required for acceptance of any citable manuscript. Authors are requested to submit manuscripts online or send as an e-mail attachment to the Editorial Office at manuscripts@longdom.org