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Milia Clinical Presentation

  • Author: Susan Cooper, MB, ChB, MD, FRCP; Chief Editor: William D James, MD  more...
Updated: Aug 18, 2015


Milia are asymptomatic. In children and adults, they usually arise around the eye. Eruptive milia, as the name suggests, have a rapid onset, often within a few weeks.



Skin lesions

Milia are superficial, uniform, pearly white to yellowish, domed lesions measuring 1-2 mm in diameter.

In milia en plaque, multiple milia arise on an erythematous plaque.[1]

Skin distribution

Primary milia, in term infants, occur on the face, especially the nose. They also may be found on the mucosa (Epstein pearls) and palate (Bohn nodules). Primary milia in older children and adults develop on the face, particularly around the eyes.[2]  Milia have been observed to occur in a transverse, linear distribution along the nasal groove in some children and around the areolae.[3, 4]

Secondary milia are found anywhere on the body at the sites affected by the predisposing condition.

Eruptive milia occur on the head, neck, and upper body.[5]

Milia en plaque manifests as distinct plaques on the head and neck. Plaques have been described in the postauricular area, unilaterally or bilaterally, the cheeks, the submandibular plaques, and on the pinna.[6, 7] A linear distribution has been described.[8]



Primary milia are believed to arise in sebaceous glands that are not fully developed, explaining the high prevalence in newborn infants.

Secondary lesions arise following blistering or trauma due to disruption of the sweat ducts. Milia have been described in association with many disorders, including bullous pemphigoid, inherited and acquired epidermolysis bullosa, bullous lichen planus, porphyria cutanea tarda, and burns. Skin trauma from dermabrasion or radiotherapy can result in milia formation. Eruptive milia have arisen during vemurafenib treatment[9]  and dovitinib treatment.[10]

Secondary milia have arisen after contact dermatitis. They have also arisen following a tattoo,[11] treatment of cutaneous leishmaniasis,[12] and after topical nitrogen mustard ointment for plaque stage mycosis fungoides.[13]

Secondary milia have been described following potent topical corticosteroid use.[14]

Milia are a feature of a number of very rare genodermatoses (eg, Bazex-Dupr é -Christol syndrome).[15] Both primary milia and multiple eruptive milia have been reported as familial disorders with autosomal dominant inheritance.[16, 17]

The etiology of milia en plaque is unknown. One case has been induced by sorafenib, a multitargeted kinase inhibitor.[18]

Contributor Information and Disclosures

Susan Cooper, MB, ChB, MD, FRCP MRCGP, FRCP, Consultant Dermatologist and Honorary Senior Clinical Lecturer, Department of Dermatology, Churchill Hospital, UK

Susan Cooper, MB, ChB, MD, FRCP is a member of the following medical societies: Royal College of Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Jeffrey P Callen, MD Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, American College of Rheumatology

Disclosure: Received income in an amount equal to or greater than $250 from: XOMA; Biogen/IDEC; Novartis; Janssen Biotech, Abbvie, CSL pharma<br/>Received honoraria from UpToDate for author/editor; Received honoraria from JAMA Dermatology for associate editor and intermittent author; Received royalty from Elsevier for book author/editor; Received dividends from trust accounts, but I do not control these accounts, and have directed our managers to divest pharmaceutical stocks as is fiscally prudent from Stock holdings in various trust accounts include some pharmaceutical companies and device makers for i inherited these trust accounts; for: Celgene; Pfizer; 3M; Johnson and Johnson; Merck; Abbott Laboratories; AbbVie; Procter and Gamble; Amgen.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Joshua A Zeichner, MD Assistant Professor, Director of Cosmetic and Clinical Research, Mount Sinai School of Medicine; Chief of Dermatology, Institute for Family Health at North General

Joshua A Zeichner, MD is a member of the following medical societies: American Academy of Dermatology, National Psoriasis Foundation

Disclosure: Received consulting fee from Valeant for consulting; Received grant/research funds from Medicis for other; Received consulting fee from Galderma for consulting; Received consulting fee from Promius for consulting; Received consulting fee from Pharmaderm for consulting; Received consulting fee from Onset for consulting.


The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Dr. Ravi Ratnavel, to the development and writing of this article.

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Milia in a week-old infant.
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