eMedicine Specialties > Dermatology > Photo-Related Diseases

Colloid Milium

Author: Susan Cooper, MB, ChB, MD, MRCGP, MRCP, Consultant Dermatologist and Honorary Senior Clinical Lecturer, Department of Dermatology, Churchill Hospital, Oxford, United Kingdom
Coauthor(s): Elizabeth Soilleux, PhD, MRCPath, Consultant Pathologist and Honorary Senior Clinical Lecturer, Department of Cellular Pathology, John Radcliffe Hospital, UK
Contributor Information and Disclosures

Updated: Oct 30, 2009

Introduction

Background

Colloid milium is a rare condition characterized by (1) the presence of multiple, dome-shaped, amber- or flesh-colored papules developing on light-exposed skin and (2) the observance of dermal colloid under light microscopy. The 4 variants are (1) an adult-onset type, (2) a nodular form (nodular colloid degeneration),1 (3) a juvenile form,2,3 and (4) a pigmented form, thought to be due to excess hydroquinone use for skin bleaching.4

Pathophysiology

Colloid milium is a degenerative condition linked to excessive sun exposure and possibly exposure to petroleum products and hydroquinone. The origin of the colloid deposition in the dermis is not certain, but it is thought to be due to degeneration of elastic fibers5,6 in the adult form and due to degeneration of UV-transformed keratinocytes in the juvenile form. Juvenile colloid milium is inherited.

Frequency

International

Colloid milium is rare, but more than 100 case reports are present in the world literature. No known figures exist on prevalence.

Mortality/Morbidity

Most cases of colloid milium persist with no natural resolution. Lesions reach their peak within 3 years, after which very few new papules occur.

Race

Colloid milium is more common in fair-skinned individuals.

Sex

The adult form of colloid milium is more common in males.

Age

The rare juvenile form of colloid milium occurs before puberty. Adult colloid milium is more common in elderly patients.

Clinical

History

Papules develop gradually over the facial area and light-exposed sites. Patients with colloid milium are usually asymptomatic, but they may have transient itching in affected areas.

Physical

The physical findings in colloid milium are usually limited to the skin.

  • Skin lesions of colloid milium: Amber, waxy, partially translucent, firm papules occur in crops, ranging from 1-5 mm in diameter. Gelatinous material can be expressed. In the nodular form, larger nodules (5-10 mm) or plaques develop. The underlying skin may be thickened, furrowed, and hyperpigmented. In the pigmented form, the papules are gray-black and confluent or clustered.
  • Skin distribution of colloid milium lesions: The lesions occur on light-exposed skin, with the cheeks, periorbital area, nose, ears, and neck most frequently involved; however, lesions may also occur on the backs of the hands and forearms. Nodules arising on one side of the face and the ipsilateral forearm have been described in a taxi cab driver. Upper eyelid margin involvement alone has been reported.7 Juvenile colloid milium may be associated with ligneous conjunctivitis or ligneous periodontitis.8 Rarely, lesions occur in the oral cavity.9

Causes

  • The classic adult and nodular forms of colloid milium are believed to be due to excessive sun exposure, which appears to cause degeneration of elastin. Evidence to support this comes from the exposed site distribution and the tendency for colloid milium to occur in individuals with fair complexions and outdoor occupations.10,11
  • The juvenile form of colloid milium is inherited, perhaps suggesting an inherited susceptibility to UV light. Autosomal recessive inheritance has been reported.12
  • An outbreak of colloid milium occurred in oil refinery workers in the tropics.13 A mechanic with occupational exposure to lubricating oils developed colloid milium over the backs of the hands.14 This may represent an interplay between light and petroleum constituents. Phenols have been suggested as causative agents.
  • Prolonged use of hydroquinones has resulted in the development of the pigmented form of colloid milium, sometimes in association with ochronosis.15

More on Colloid Milium

Overview: Colloid Milium
Differential Diagnoses & Workup: Colloid Milium
Treatment & Medication: Colloid Milium
Follow-up: Colloid Milium
Multimedia: Colloid Milium
References
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References

  1. Patterson JW, Wilkin JK, Schatzki PF. Nodular colloid degeneration: distinctive histochemical and ultrastructural features. Cutis. Oct 1985;36(4):355-8. [Medline].

  2. Oskay T, Erdem C, Anadolu R, Peksan Y, Ozsoy N, Gul N. Juvenile colloid milium associated with conjunctival and gingival involvement. J Am Acad Dermatol. Dec 2003;49(6):1185-8. [Medline].

  3. Handfield-Jones SE, Atherton DJ, Black MM, Hashimoto K, McKee PH. Juvenile colloid milium: clinical, histological and ultrastructural features. J Cutan Pathol. Oct 1992;19(5):434-8. [Medline].

  4. Gonul M, Cakmak SK, Kilic A, Gul U, Heper AO. Pigmented coalescing papules on the dorsa of the hands: pigmented colloid milium associated with exogenous ochronosis. J Dermatol. Apr 2006;33(4):287-90. [Medline].

  5. Kobayashi H, Hashimoto K. Colloid and elastic fibre: ultrastructural study on the histogenesis of colloid milium. J Cutan Pathol. Apr 1983;10(2):111-22. [Medline].

  6. Hashimoto K, Miller F, Bereston ES. Colloid milium. Histochemical and electron microscopic studies. Arch Dermatol. May 1972;105(5):684-94. [Medline].

  7. Muzaffar W, Dar NR, Malik AM. Colloid milium of the upper eyelid margins: a rare presentation. Ophthalmology. Oct 2002;109(10):1944-6. [Medline].

  8. Chowdhury MM, Blackford S, Williams S. Juvenile colloid milium associated with ligneous conjunctivitis: report of a case and review of the literature. Clin Exp Dermatol. Mar 2000;25(2):138-40. [Medline].

  9. Ojha J, Bhattacharyya I, Islam NM, Wong F, Cohen DM. Colloid milium of the oral cavity: a rare presentation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Apr 2008;105(4):e34-8. [Medline].

  10. Lewis AT, Le EH, Quan LT, Krishnan B, Schulmeier J, Hsu S. Unilateral colloid milium of the arm. J Am Acad Dermatol. Feb 2002;46(2 Suppl Case Reports):S5-7. [Medline].

  11. Innocenzi D, Barduagni F, Cerio R, Wolter M. UV-induced colloid milium. Clin Exp Dermatol. Jul 1993;18(4):347-50. [Medline].

  12. Percival GH, Duthie DA. Notes on a case of colloid pseudomilium. Br J Dermatol Syph. Dec 1948;60(12):399-404. [Medline].

  13. Holzberger PC. Concerning adult colloid milium. Arch Dermatol. Nov 1960;82:711-6. [Medline].

  14. Muscardin LM, Bellocci M, Balus L. Papuloverrucous colloid milium: an occupational variant. Br J Dermatol. Oct 2000;143(4):884-7. [Medline].

  15. Findlay GH, Morrison JG, Simson IW. Exogenous ochronosis and pigmented colloid milium from hydroquinone bleaching creams. Br J Dermatol. Dec 1975;93(6):613-22. [Medline].

  16. Lever WG. Colloid milium and nodular colloid degeneration. In: Lever's Histopathology of the Skin. 8th ed. Philadelphia, Pa: WB Saunders; 1997:373-5.

  17. Lai KW, Lambert E, Coleman S, Scott G, Mercurio MG. Nodular amyloidosis: differentiation from colloid milium by electron microscopy. Am J Dermatopathol. Jul 2009;31(5):472-4. [Medline].

  18. Field LM. Re: the long pulsed Er:YAG laser and intravenous sedation versus dermabrasion (or laser) utilizing tumescent anesthesia for colloid milium. Dermatol Surg. Aug 2002;28(8):780. [Medline].

  19. Ammirati CT, Giancola JM, Hruza GJ. Adult-onset facial colloid milium successfully treated with the long-pulsed Er:YAG laser. Dermatol Surg. Mar 2002;28(3):215-9. [Medline].

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Further Reading

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Keywords

colloid milium, colloid pseudomilium, colloid degeneration of the skin, nodular colloid degeneration, elastosis colloidalis conglomerata, colloid infiltration, military colloidoma, hyaloma

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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.

Coauthor(s)

Elizabeth Soilleux, PhD, MRCPath, Consultant Pathologist and Honorary Senior Clinical Lecturer, Department of Cellular Pathology, John Radcliffe Hospital, UK
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

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Edward F Chan, MD, Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine
Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Catherine M Quirk, MD, Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania
Catherine M 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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