Hot, hot, hot.

Katherine was showing me her "sweat bubbles" tonight.
What, you may ask, are "sweat bubbles?" I asked that too.
Apparently, they are tiny pockets of skin that bubble up and burst, releasing saline, when she gets really hot.
I think this is strange. And unusual. I think she may once again be a medical mystery.
I need to google sweat bubbles.


Voila. I have diagnosed Katherine with the help of google and eMedicine.

"The primary stimuli for the development of miliaria are conditions of high heat and humidity that lead to excessive sweating. Occlusion of the skin due to clothing, bandages, or plastic sheets (in an experimental setting) can further contribute to pooling of sweat on the skin surface and overhydration of the stratum corneum. In susceptible persons, including infants, who have relatively immature eccrine glands, overhydration of the stratum corneum is thought to be sufficient to cause transient blockage of the acrosyringium.

If hot humid conditions persist, the individual continues to produce excessive sweat, but he or she is unable to secrete the sweat onto the skin surface because of ductal blockage. This blockage results in the leakage of sweat en route to the skin surface, either in the dermis or epidermis, with relative anhidrosis.

When the point of leakage is in the stratum corneum or just below it, as in miliaria crystallina, little accompanying inflammation is present, and the lesions are asymptomatic. In contrast, in miliaria rubra, the leakage of sweat into the subcorneal layers produces spongiotic vesicles and a chronic periductal inflammatory cell infiltrate in the papillary dermis and lower epidermis. In miliaria profunda, the escape of sweat into the papillary dermis generates a substantial, periductal lymphocytic infiltrate and spongiosis of the intra-epidermal duct."

That's my hon bun. A never-ending source of physical findings.
I hope one of my patients in my Thursday medicine clinic suffers from milaria crystallina.