How to beat heat rash

Q:  I have a heat rash from the hot weather we’ve been having recently. What’s the best way to get rid of it?
Donna developed redness and itching in her groin area during a recent heatwave. She first tried applying Gold Bond powder to her red, itchy skin, but it didn't seem to help. Next, she asked us for help.  
Heat rash is also called prickly heat or miliaria. It can happen to anyone with active sweat glands. Nearly 40% of infants will experience the discomfort of a heat rash. Prickly heat also afflicts physically active people in the summer heat who sweat while doing strenuous physical work, performing sports, exercising, even gardening.
Heat rash is caused by clogged sweat glands. When sweat builds up under your skin, instead of being released through pores in your skin, it can become trapped. The fluid trapped inside your pores can cause swelling and eventually ruptures the pore. This creates small red, raised lesions that burn or itch.
Heat rash can be small clusters of itchy lesions or as a rash spread out over larger areas of the body. Outbreaks can occur anywhere your sweat tends to collect: your armpits, chest, upper back, belly, and groin. If the pore blockage is severe enough, it creates inflammation, pustules, even yeast infections.
Heat rash or prickly heat can also happen to people who have been treating dry, itchy skin with heavy creams or ointments. Applying a thick, occlusive layer of cream or ointment can help relieve dryness and itching by trapping moisture inside the top layer of your skin. Unfortunately, during hot weather, this approach can backfire and plug your hard-working sweat glands, triggering heat rash.
The first key to relieving the itching and burning of prickly heat is to keep your skin dry so your pores can breathe. One of the best ways to do that is to discourage excess sweating. Increasing airflow to your skin is essential. Wearing loose, lightweight clothing and using fans to encourage air circulation discourages excessive sweating. Fevers can also cause profuse perspiration.
The second key to relieving heat rash is to avoid blocking overworked sweat glands with oils, heavy creams, or ointments. Keep areas that perspire heavily free of moisturizers, especially your groin area, behind your knees, under your arms, or between any skin folds.
The third key to treating prickly heat is to avoid applying medicated or plain powders to irritated or broken skin. Powders can clog inflamed pores and sweat glands, so it's best to stay away from them entirely until your skin has calmed down.
Heat rash often creates intense itching with an almost uncontrollable urge to scratch. Scratching the itchy area feels good but gives only temporary relief. The friction of scratching actually triggers increased inflammation and itching.
One way to soothe itching is by applying soft cloths dampened with cool water, along with either a non-prescription steroid cream like 1% hydrocortisone or aloe vera gel. Avoid applying Benadryl cream or spray, as it can be irritating and isn’t as effective for relief of itching as the capsules or liquid.
Aloe vera gel can be used on broken or intact skin. Hydrocortisone 1% cream is safe to use on small areas of broken skin or larger spaces of unbroken skin in adults. Avoid applying hydrocortisone cream to broken skin in infants and children.
Here are 7 Tips for Treating Prickly Heat or Heat Rash:
1.I ncrease airflow.
Wear lightweight, loose clothing or no clothing at all. House fans can help circulate air over your skin.
2.I ncrease evaporation.
A sponge bath with lukewarm water helps cool and dry your skin. Avoid hot water, which can increase inflammation. Adding oatmeal or a similar product like Aveeno® can help soothe irritated skin.
3. Avoid applying powder to irritated, broken skin.
Powders can clog sweat glands. Avoid using powders until the acute symptoms of redness and itching subside.
4. Avoid using heavy creams and ointments that can block your pores.
5. Keep your armpits, groin, chest, and any skin folds as dry as possible.
To help absorb excess perspiration, try tucking a lightweight cloth, like a pillowcase, between any skin folds, and change it frequently.
6. Cool it before you use it.
For additional soothing power, refrigerate your Aloe vera gel or hydrocortisone cream before applying it.
7. Contact your doctor.
If these strategies don't help the itching and irritation of heat rash, contact your doctor. Other conditions may look like heat rash at first but need to be treated differently.

Dr. Louise Achey, Doctor of Pharmacy, is a 42-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Get clear answers to your medication questions at her website and blog TheMedicationInsider.com.® 2021 Louise Achey

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