eMedicine Specialties > Dermatology > Benign Neoplasms

Milia

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

Updated: May 6, 2008

Introduction

Background

Milia are very common, benign, keratin-filled cysts. Primary milia are typically seen in infants but also may occur in children and adults. Secondary milia are observed in a number of blistering disorders and following dermabrasion. Milia en plaque and multiple eruptive milia are distinct entities.

The eMedicine Pediatrics article Milia may be of interest, as may the Medscape Dermatologic Surgery Resource Center.

Pathophysiology

Milia are tiny epidermoid cysts. The cysts may be derived from the pilosebaceous follicle. Primary milia arise on facial skin bearing vellus hair follicles. Secondary milia result from damage to the pilosebaceous unit.

Frequency

United States

Primary milia in newborns are so common that they can be considered normal (occurring in approximately half of all infants). Multiple eruptive milia and milia en plaque are rare entities.

Race

No racial predilection is recognized.

Sex

Sexual prevalence is equal for primary and secondary milia. Eruptive milia and milia en plaque occur more frequently in women.

Age

Milia occur in persons of all ages but are typically found in infants.

Clinical

History

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.

Physical

  • 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.3
    • 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.4
    • 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.5,6

Causes

  • 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.
  • Secondary milia have arisen from a bullous contact dermatitis7 and a photocontact allergy to sunscreen.8  They have also arisen following treatment of cutaneous leishmaniasis9 and after topical nitrogen mustard ointment for plaque stage mycosis fungoides.10
  • Secondary milia have been described following potent topical corticosteroid use.11
  • Milia are a feature of a number of very rare genodermatoses (eg, Bazex-Dupr é -Christol syndrome).12  Both primary milia and multiple eruptive milia have been reported as familial disorders with autosomal dominant inheritance.13
  • The etiology of milia en plaque is unknown.

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. 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].

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

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

  7. Inman P. Milia following bullous dermatitis. Br J Dermatol. Feb 1969;81(2):132-3. [Medline].

  8. Bryden AM, Ferguson J, Ibbotson SH. Milia complicating photocontact allergy to absorbent sunscreen chemicals. Clin Exp Dermatol. Nov 2003;28(6):668-9. [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. Barcelos AC, Nico MM. Bazex-Dupré-Christol syndrome in a 1-year-old boy and his mother. Pediatr Dermatol. Jan-Feb 2008;25(1):112-3. [Medline].

  13. 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].

  14. Kotsuji T, Imakado S, Iwasaki N, Fujisawa H, Otsuka F. Milia-like idiopathic calcinosis cutis in a patient with translocation Down syndrome. J Am Acad Dermatol. Jul 2001;45(1):152-3. [Medline].

  15. 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].

  16. 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].

  17. 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].

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

  19. 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].

  20. 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

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, 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

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

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other; american college of physicians Honoraria Other

 
 
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