Milia Clinical Presentation

Updated: Mar 10, 2017
  • Author: Charles M G Archer, MBBS, MRCP(UK); Chief Editor: William D James, MD  more...
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Presentation

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.

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Physical Examination

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 and around the areolae. [3, 4]

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. [5]

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. [6, 7] A linear distribution has been described. [8]

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Causes

Primary milia are believed to arise in sebaceous glands that are not fully developed, explaining the high prevalence in newborn infants. New evidence suggests that milia may originate from the outermost layers of the hair bulge of the outer root sheath. [9]

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. Eruptive milia have arisen during vemurafenib treatment [10]  and dovitinib treatment. [11]

Secondary milia have arisen after contact dermatitis. They have also arisen following a tattoo, [12] treatment of cutaneous leishmaniasis, [13] and after topical nitrogen mustard ointment for plaque stage mycosis fungoides. [14]

Secondary milia have been described following potent topical corticosteroid use. [15]

Milia are a feature of a number of very rare genodermatoses (eg, Bazex-Dupré-Christol syndrome). [16] Both primary milia and multiple eruptive milia have been reported as familial disorders with autosomal dominant inheritance. [17, 18]

The etiology of milia en plaque is unknown. One case has been induced by sorafenib, a multitargeted kinase inhibitor. [19]

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Complications

No systemic complications have been reported.

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