Health

INTRODUCTION“Miliaria” is the general term used to describe conditions caused by blockage within the sweat duct. Eccrine miliaria is a common, transient cutaneous disorder caused by blockage within the eccrine sweat duct. It is also known as “sweat rash,” “prickly heat,” or “heat rash.”CAUSES:Anything that causes sweating can lead to eccrine miliaria in infants, children, and adults. Common causes include:●Hot and humid environments●Strenuous physical activity●Febrile illness [6]●Occlusion of the skinCLINICAL MANIFESTATIONSThe clinical features of miliaria crystallina, miliaria rubra, and miliaria profunda are reviewed below:●Miliaria crystallina – Results from superficial blockage of the sweat duct (within the stratum corneum) and is characterized by superficial, clear 1 to 2 mm vesicles that resemble water droplets. The vesicles may coalesce. Due to their superficial location, the vesicles rupture easily and do not cause a significant inflammatory response. ●Miliaria rubra – Results from blockage of the duct, usually within the epidermis, although it can occur in the dermis. Leakage of sweat causes inflammation in the periductal tissue. Miliaria rubra is characterized by erythematous 2 to 4 mm papules. They may be papulovesicular or pustular. ●Miliaria profunda – Caused by blockage deeper within the sweat duct (at the dermal-epidermal junction or below). It usually occurs after repeated episodes of miliaria rubra. Escape of sweat into the surrounding tissues results in erythematous to skin-colored, firm papules 1 to 4 mm in diameter. The papules are non-follicular. It is most common in adult males, especially military personnel stationed in tropical climatesSeen most in adults, miliaria profunda usually occurs on the trunk but can be seen on the extremities as well. Because sweat is obstructed deeply within the skin, affected areas show little or no sweating. The eruption is typically asymptomatic. It may also be subtle and become more visible when the patient sweats. ●Management•General measures – Treatment of miliaria revolves around minimizing exposure to factors that stimulate sweating and occlusion of eccrine sweat glands. This approach includes the following measures:-Move patient to a cooler environment if possible-Wear breathable clothing (such as cotton) that does not occlude the skin-Remove occlusive bandages or medication patches in the affected area and use more porous alternatives if needed-Treat fever with antipyretics  

For Uncomplicated Falciparum malaria (Adult >35 kg) The first line treatment for falciparum malaria is artemether + lumefantrine (AL) given over three days and a single dose primaquine.  (6 doses) STAT-8Hrs- then BD for 2 more days. NOTE: Take after a full meal or whole milk. If a patient vomits within 30 minutes of taking a dose, he or she should repeat the dose. Ideally, the first two doses should be taken 8 hours apart. For Complicated Falciparum Malaria (Severe): Intravenous or intramuscular artesunate for at least 24 h and until the patient can tolerate oral medication. Once a patient has received at least 24h of parenteral therapy and can tolerate oral therapy, complete treatment with full course artemether + lumefantrine (AL). Inj. Artesunate 2.4 mg/kg STAT, 12 hours and 24hours and then OD until oral medication is tolerated. If Artemisinin combination therapy is not available and chloroquine sensitive species. Dosage Distribution: Chloroquine- Day 1: chloroquine is given at an initial dose of 10 mg base/kg body weight, Day 2: followed by 10 mg/kg body weight, Day 3: 5 mg/kg body weight. Primaquine- 0.25 mg/kg body weight per day. Artemether and Lumefantrine- Total dose of 5-24 mg/kg of artemether and 29-144 mg /kg of lumefantrine.