Colloid Milium Clinical Presentation

Updated: Mar 06, 2017
  • Author: Gorav Neel Wali, BMBCh, MA, MRCP; Chief Editor: Dirk M Elston, MD  more...
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Presentation

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.

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Physical Examination

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. [14] One case report describes nodular colloid milium affecting the conjunctiva and anterior orbit. [15] Juvenile colloid milium may be associated with ligneous conjunctivitis or ligneous periodontitis. [16] Rarely, lesions occur in the oral cavity. [17]

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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. [7, 8]

The juvenile form of colloid milium is inherited, perhaps suggesting an inherited susceptibility to UV light. Autosomal recessive inheritance [9] and a familial case affecting father and son [10] have been reported.

An outbreak of colloid milium occurred in oil refinery workers in the tropics. [11] A mechanic with occupational exposure to lubricating oils developed colloid milium over the backs of the hands. [12] 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. [13]

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