Colloid Milium Workup

  • Author: Susan Cooper, MB, ChB, MD, MRCGP, FRCP; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Aug 2, 2011
 

Procedures

  • Skin biopsy in colloid milium
    • Light microscopy is necessary.
    • Electron microscopy may be necessary to distinguish between colloid and amyloid because these 2 entities look similar under light microscopy.
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Histologic Findings

Typically, fissured eosinophilic colloid masses are seen in the dermis.[17]

In the classic adult form of colloid milium, the colloid is located in the upper and mid dermis and in defined islands, with a very superficial, subepidermal layer of the papillary dermis usually being spared (grenz zone). The colloid has a homogeneous eosinophilic appearance with some fissuring. Fibroblasts may be aligned along the edges of these fissures. Solar elastosis is marked and closely approximated to the colloid. Hair follicles and sebaceous glands are well preserved.

In the nodular form of colloid milium, the vast majority of the dermis is filled with glassy eosinophilic colloid.

In the pigmented form of colloid milium, deposits are similar to those of the classic adult form of colloid milium, except that they show a light-golden pigmentation similar to ochronosis.

In the juvenile form of colloid milium, the grenz zone is usually absent, with the islands of amorphous colloid lying close to the basal layer of the epidermis. These islands show some clefting with intervening spindle or stellate fibroblasts. Solar elastosis is absent. In the nodular form of colloid milium, the vast majority of the dermis is filled with colloid.

Because colloid cannot be distinguished from amyloid under light microscopy alone and because colloid, like amyloid, stains positively for periodic acid-Schiff stain, it can be difficult to distinguish it from amyloid. However, colloid is usually negative for the amyloid stain methyl (crystal) violet. Colloid may also sometimes yield weakly positive results and may show green birefringence with Congo red stain. Amyloid in the skin frequently immunostains positively for cytokeratin or immunoglobulin light chain, which colloid should not. However, if these special stains and immunostains prove inconclusive, electron microscopy may be necessary.[6, 18]

Hematoxylin and eosin–stained section of skin (X40Hematoxylin and eosin–stained section of skin (X40) showing a central focus of amorphous, eosinophilic, homogenous colloid with surrounding fissuring. Elastic van Gieson stain of the same area showing Elastic van Gieson stain of the same area showing strong (black) staining of the colloid for elastin.
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Contributor Information and Disclosures
Author

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

Susan Cooper, MB, ChB, MD, MRCGP, FRCP 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.

Specialty Editor Board

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.

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.

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.

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, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgments

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

References

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  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].

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  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. Martorell-Calatayud A, Balmer N, Sanmartin O, Botella-Estrada R, Requena C, Guillen-Barona C. Familial juvenile colloid milium: report of a well documented case. J Am Acad Dermatol. Jan 2011;64(1):203-6. [Medline].

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

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

  16. 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].

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

  18. 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].

  19. 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].

  20. 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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Hematoxylin and eosin–stained section of skin (X40) showing a central focus of amorphous, eosinophilic, homogenous colloid with surrounding fissuring.
Elastic van Gieson stain of the same area showing strong (black) staining of the colloid for elastin.
 
 
 
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