eMedicine Specialties > Pediatrics: General Medicine > Dermatology

Milia

Ruchir Agrawal, MD,, Chief, Allergy and Immunology, Aurora Sheboygan Clinic

Updated: Mar 13, 2009

Introduction

Background

Milia are benign, self-limited lesions that manifest as tiny white bumps on the forehead, nose, upper lip, and cheeks of the newborn.¹

Milia in a week old infant.

Pathophysiology

Milia is observed as small multiple cysts ranging from 1-2 mm in diameter. Histologically, these cysts are multiple superficial inclusion cysts that involve the follicular infundibulum (upper part of the hair follicle). They contain keratin and surrounded by a dense lymphocytic infiltrate.² No visible opening is present.

Frequency

United States

Approximately 40% of newborn infants develop milia. This condition is mainly associated with newborns carried to full term or nearly to term. Typically, the rash appears after 4-5 days in full-term newborns.³ Infants born prematurely are less commonly affected. Manifestations of milia may be delayed from days to weeks in infants born before term.

Race

No racial predilection is observed.

Sex

No sexual predilection is noted.

Age

Rash appears in neonates 1-2 days after birth. It can be delayed for days to weeks in neonates born prematurely.

Clinical

Physical

The milia lesions range from 1-2 mm in size and are papular. They are pearly opalescent lesions and mostly present on the face. These lesions are called Epstein pearls when present on the soft or hard palate.

Differential Diagnoses

Erythema Toxicum
Herpes Simplex Virus Infection
Neonatal Pustular Melanosis

Workup

Laboratory Studies

No laboratory studies are required.

Treatment

Medical Care

Most of the milia lesions disappear in infants by age 1-2 months. Application of creams or ointments is not recommended.

Activity

Milia is not infectious and is noncommunicable. No isolation or restriction of activity is required.

Medication

Drug therapy currently is not a component of the standard of care for this condition.

Follow-up

Prognosis

Prognosis is excellent because milia is a benign self-limiting rash. Milial lesions disappear in a few days without leaving any scars.

Patient Education

Educate the family about the benign course of milia. No drug therapy is required. Use of any over-the-counter rash medications is not recommended.
For excellent patient education resources, visit eMedicine's Children's Health Center. Also, see eMedicine's patient education article Skin Rashes in Children.

Multimedia

Media file 1: Milia in a week old infant.

References

Berk DR, Bayliss SJ. Milia: a review and classification. J Am Acad Dermatol. Dec 2008;59(6):1050-63. [Medline].
Rutter KJ, Judge MR. Profuse congenital milia in a family. Pediatr Dermatol. Jan-Feb 2009;26(1):62-4. [Medline].
O'Connor NR, McLaughlin MR, Ham P. Newborn skin: Part I. Common rashes. Am Fam Physician. Jan 1 2008;77(1):47-52. [Medline].
Clemons RM. Issues in newborn care. Prim Care. Mar 2000;27(1):251-67. [Medline].
Johr RH, Schachner LA. Neonatal dermatologic challenges. Pediatr Rev. Mar 1997;18(3):86-94. [Medline].
Lorenz S, Maier C, Segerer H. [Skin changes in newborn infants in the first 5 days of life]. Hautarzt. Jun 2000;51(6):396-400. [Medline].
Mallory SB. Neonatal skin disorders. Pediatr Clin North Am. Aug 1991;38(4):745-61. [Medline].

Keywords

milia, neonatal rash, Epstein pearls, inclusion cysts, lesions, bumps, benign lesions, benign bumps, benign cysts, babies, newborns

Contributor Information and Disclosures

Author

Ruchir Agrawal, MD,, Chief, Allergy and Immunology, Aurora Sheboygan Clinic
Ruchir Agrawal, MD, is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American College of Allergy, Asthma and Immunology, and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Kevin P Connelly, DO, Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University; Medical Director, Paws for Health Pet Visitation Program of the Richmond SPCA; Pediatric Emergency Physician, Emergency Consultants Inc, Chippenham Medical Center
Kevin P Connelly, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

CME Editor

Merrily P M Poth, MD, Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences
Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
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.

Further Reading