eMedicine Specialties > Dermatology > Benign Neoplasms

Milia: Differential Diagnoses & Workup

Author: Susan Cooper, MB, ChB, MD, MRCGP, MRCP, Consultant Dermatologist and Honorary Senior Clinical Lecturer, Department of Dermatology, Churchill Hospital, Oxford, United Kingdom
Contributor Information and Disclosures

Updated: Sep 23, 2009

Differential Diagnoses

Acne Vulgaris
Syringoma
Trichoepithelioma

Other Problems to Be Considered

Milialike idiopathic calcinosis cutis (particularly in persons with Down syndrome)

Workup

Laboratory Studies

  • No investigations are needed for simple milia. The clinical appearance is diagnostic.
  • Investigation of the underlying disease is necessary in persons with secondary milia.

Procedures

  • Performing a skin biopsy is necessary only if the diagnosis is in doubt.
    • If milia en plaque is suspected, performing a biopsy is prudent to exclude follicular mucinosis and multiple trichoepitheliomata.
    • In an elderly person with sun-damaged skin, Favre-Racouchet syndrome (nodular elastosis of the skin) needs to be excluded.

Histologic Findings

The histological features are identical to those of epidermoid cysts, but the cysts are much smaller. The milium is usually located in the superficial dermis and has a complete epithelial lining (with a granular cell layer). It contains a variable amount of lamellated keratin. The common primary milia in infants and children are found in the undifferentiated sebaceous hair collar surrounding vellus hair follicles. Milia secondary to blistering are often found in eccrine sweat ducts.

More on Milia

Overview: Milia
Differential Diagnoses & Workup: Milia
Treatment & Medication: Milia
Follow-up: Milia
References
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References

  1. Losada-Campa A, De La Torre-Fraga C, Cruces-Prado M. Milia en plaque. Br J Dermatol. May 1996;134(5):970-2. [Medline].

  2. Ratnavel RC, Handfield-Jones SE, Norris PG. Milia restricted to the eyelids. Clin Exp Dermatol. Mar 1995;20(2):153-4. [Medline].

  3. Akinduro OM, Burge SM. Congenital milia in the nasal groove. Br J Dermatol. Jun 1994;130(6):800. [Medline].

  4. Berk DR, Bayliss SJ. Milium of the areola: a novel regional variant of primary milia. Pediatr Dermatol. Jul-Aug 2009;26(4):485-6. [Medline].

  5. Langley RG, Walsh NM, Ross JB. Multiple eruptive milia: report of a case, review of the literature, and a classification. J Am Acad Dermatol. Aug 1997;37(2 Pt 2):353-6. [Medline].

  6. Garcia Sanchez MS, Gomez Centeno P, Rosen E, Sanchez-Aguilar D, Fernandez-Redondo V, Toribio J. Milia en plaque in a bilateral submandibular distribution. Clin Exp Dermatol. Sep 1998;23(5):227-9. [Medline].

  7. Calabrese P, Pellicano R, Lomuto M, Castelvetere M. Milia en plaque. J Eur Acad Dermatol Venereol. Mar 1999;12(2):195-6. [Medline].

  8. Kautz O, Muller S, Braun-Falco M, Nashan D. Milia en plaque in a linear pattern. J Eur Acad Dermatol Venereol. Feb 27 2009;[Medline].

  9. Del Giudice P. Milia and cutaneous leishmaniasis. Br J Dermatol. May 2007;156(5):1088. [Medline].

  10. Kalayciyan A, Oguz O, Demirkesen C, Serdaroglu S, Kotogyan A. Milia in regressing plaques of mycosis fungoides: provoked by topical nitrogen mustard or not?. Int J Dermatol. Dec 2004;43(12):953-6. [Medline].

  11. Iacobelli D, Hashimoto K, Kato I, Ito M, Suzuki Y. Clobetasol-induced milia. J Am Acad Dermatol. Aug 1989;21(2 Pt 1):215-7. [Medline].

  12. Berk DR, Bayliss SJ. Milia: a review and classification. J Am Acad Dermatol. Dec 2008;59(6):1050-63. [Medline].

  13. Rutter KJ, Judge MR. Profuse congenital milia in a family. Pediatr Dermatol. Jan-Feb 2009;26(1):62-4. [Medline].

  14. Heard MG, Horton WH, Hambrick GW Jr. The familial occurrence of multiple eruptive milia. Birth Defects Orig Artic Ser. Jun 1971;7(8):333-7. [Medline].

  15. Chappell JA, Burkemper NM, Semchyshyn N. Localized dyskeratotic plaque with milia associated with sorafenib. J Drugs Dermatol. Jun 2009;8(6):573-6. [Medline].

  16. Connelly T. Eruptive milia and rapid response to topical tretinoin. Arch Dermatol. Jun 2008;144(6):816-7. [Medline].

  17. Ishiura N, Komine M, Kadono T, Kikuchi K, Tamaki K. A case of milia en plaque successfully treated with oral etretinate. Br J Dermatol. Dec 2007;157(6):1287-9. [Medline].

  18. Thami GP, Kaur S, Kanwar AJ. Surgical Pearl: Enucleation of milia with a disposable hypodermic needle. J Am Acad Dermatol. Oct 2002;47(4):602-3. [Medline].

  19. George DE, Wasko CA, Hsu S. Surgical pearl: evacuation of milia with a paper clip. J Am Acad Dermatol. Feb 2006;54(2):326. [Medline].

  20. Sandhu K, Gupta S, Handa S. CO2 laser therapy for Milia en plaque. J Dermatolog Treat. Dec 2003;14(4):253-5. [Medline].

  21. van Lynden-van Nes AM, der Kinderen DJ. Milia en plaque successfully treated by dermabrasion. Dermatol Surg. Oct 2005;31(10):1359-62, discussion 1362. [Medline].

  22. Noto G, Dawber R. Milia en plaque: treatment with open spray cryosurgery. Acta Derm Venereol. Oct-Nov 2001;81(5):370-1. [Medline].

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Further Reading

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Keywords

milia, blistering disorders, milia en plaque, multiple eruptive milia, newborn skin lesions, infant skin lesions, infant plaques, epidermoid cysts, keratin-filled cysts, primary milia, secondary milia, dermabrasion, Epstein pearls, bullous pemphigoid, inherited epidermolysis bullosa, acquired epidermolysis bullosa, bullous lichen planus, porphyria cutanea tarda, burns, radiotherapy, blistering contact dermatitis, photocontact allergy to sunscreen, mycosis fungoides, genodermatosis

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Contributor Information and Disclosures

Author

Susan Cooper, MB, ChB, MD, MRCGP, MRCP, Consultant Dermatologist and Honorary Senior Clinical Lecturer, Department of Dermatology, Churchill Hospital, Oxford, United Kingdom
Susan Cooper, MB, ChB, MD, MRCGP, MRCP is a member of the following medical societies: Royal College of Physicians
Disclosure: Nothing to disclose.

Medical Editor

Marjan Garmyn, MD, PhD, Professor, Faculty of Medicine, Katholieke Universiteit Leuven, Belgium; Chair and Adjunct Head, Department of Dermatology, University of Leuven, Belgium
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey P Callen, MD, Professor of Medicine, 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, and American College of Rheumatology
Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Electrical Optical Sciences Honoraria Consulting; Centocor Honoraria Consulting; Medicis Honoraria Consulting; Celgene Honoraria Consulting

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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