Granulomatous variant of giant centrifugal miliaria profunda
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Miliarias are a group of eccrine disorders having in common retention of sweat due to occlusion of the sweat duct producing a clinically heterogeneous eruption. Three variants of miliaria have been defined according to the depth at which this sweat duct obstruction occurs. Miliaria profunda refers to the development of flesh-coloured papules resembling gooseflesh, associated with obstruction of the sweat duct near the dermoepidermal junction.

A 10-month-old infant with congenital pelviureteric junction obstruction and hydronephrosis was referred from the paediatric surgery department, in view of asymptomatic red raised lesions all over body since 1 month in the winter season. Patient gave history of similar lesions on the extremities six months back, which resolved on application of topical steroid containing creams. There was no history of consanguinity in parents. Mother had history of autoimmune hypothyroidism and was on thyroxine supplementation. Infant was diagnosed with non-autoimmune hypothyroidism at two months of age, and was started on levothyroxine 25 microgram.

General examination revealed dysmorphic facies with depressed nasal bridge. The patient was afebrile. Thyroid was impalpable. Cutaneous examination showed multiple skin coloured to erythematous papules coalescing to form infiltrated annular plaques mainly over occipital scalp, neck, ear helices, proximal extremities, elbows, knees, buttocks, dorsa of hands and feet and few over trunk. There was no evidence of scaling. Hair were dry and sparse and nails were normal.

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