ABSTRACT
Objectives: To report a rare case of extensive congenital miliaria crystallina. Results: A male infant was born at term by Caesarian section due to warning signs of fetal distress. The pregnancy had been uneventful. However, a maternal SARS-CoV2-infection occurred 2 days before birth. Immediately at birth, the newborn presented with a striking appearance of disseminated pinpoint-sized vesicles filled with clear fluid. Preemptive antibiotic treatment was initiated On dermatology consult, a diagnosis of congenital miliaria crystallina was made due to the typical clinical presentation. Investigations for congenital infections (Herpes, Varicella) were negative as well as repeat sampling for SARSCoV2. Antibiotic treatment was stopped. Treatment included reduction of ambient temperature/humidity and disinfectant dressings leading to a quick resolution of miliaria within 2-3 days. Clinical follow-up on DOL 20 revealed normal skin with areas of flaky desquamation. Discussion: Miliaria is a benign, transient disorder caused by occlusion and disruption of eccrine sweat ducts and occasionally occurs in infants. Congenital presentation of extensive miliaria crystallina however is exceptional with only sporadic reports in the medical literature. The role of SARS-CoV2 in our case remains unclear as fetal infection was excluded. However, a few cases of congenital miliaria were reported in the context of other maternal infections, suggesting a role of maternal fever and increased temperature of amniotic fluid in the pathogenesis of congenital miliaria. Clinicians should be aware of this striking yet harmless congenital presentation, which may mimic a congenital disorder of cornification or another severe skin disease, causing unnecessary anxiety.