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Milia are very common, benign, keratin-filled epidermoid cysts that occur in individuals of all ages, from infants to elderly persons.
- Primary milia are typically seen in infants but may also occur in children and adults. Primary milia arise on facial skin bearing vellus hair follicles.
- Secondary milia result from damage to the pilosebaceous unit.
- Milia en plaque and multiple eruptive milia are distinct entities.
- Milia are common in all ages and both sexes. Milia affect approximately 50% of infants.
- Multiple eruptive milia and milia en plaque are rare.
- Milia are superficial, uniform, pearly-white to yellowish, domed lesions measuring 1-2 mm in diameter.
- Milia most often arise on the face and are particularly prominent on the eyelids and cheeks, but they may occur elsewhere.
- They are usually asymptomatic but may be itchy.
- Primary milia in infants occur on the face, especially the cheeks, nose and around the eyes. They may be more widespread on the scalp, face and upper trunk.
- They may also be found on the mucosa (Epstein's pearls) and palate (Bohn's nodules).
- In older children and adults, they also develop on the face, particularly around the eyes.
- Primary milia in children and adults are most often on the eyelids, cheeks, forehead and genitalia. They may clear in a few weeks or persist for months or longer.
- Juvenile milia may be present at birth or appear later in life. They may be associated with Gardner's syndrome and other genetic disorders.
Milia en plaque
- The small papules arise on a distinct, erythematous plaque in the postauricular area, unilaterally or bilaterally.
- They are usually seen on the eyelids, behind the ears, on cheeks or on the jaw. Submandibular plaques and lesions on the pinna have been reported.
- They especially affect middle-aged women and may be associated with other skin disease, eg pseudoxanthoma elasticum, discoid lupus erythematosus, lichen planus.
Multiple eruptive milia
- These are found anywhere on the body where there has been a predisposing condition.
- Traumatic milia occur at site of injury as skin heals, eg following burns or blistering rashes.
- Milia may rarely follow the use of topical medication, eg 5-fluorouracil cream, corticosteroid creams.
- The clinical appearance is diagnostic in simple milia and no further investigations are required.
- In elderly people with sun-damaged skin, a biopsy is needed to exclude nodular elastosis of the skin (Favre-Racouchot syndrome). If milia en plaque are suspected, a biopsy is prudent to confirm the diagnosis.
- Acne vulgaris.
- Lichen planus follicularis tumidus.
- Follicular mucinosis.
Another differential diagnosis is closed comedones which are more cream than white. They also usually have a small punctum as well as being associated with open (black) comedones.
Primary care management
- Often no treatment is required.
- Some milia may be removed with a needle, as they often shell out easily.
- Topical peeling agents do not work.
They are harmless but unsightly. They tend to resolve within a few weeks in infants but may persist in older children and adults, requiring removal with a needle (no anaesthetic is required).
When to refer
For confirmation of diagnosis or reassurance. It is worth referring patients with suspected milia en plaque.
Further reading & references
- Berk DR, Bayliss SJ; Milia: a review and classification. J Am Acad Dermatol. 2008 Dec;59(6):1050-63. Epub 2008 Sep 25.
- Cooper S; Milia, Medscape, Aug 2011
- Milium, milia, DermNet NZ, Jun 2011
- Garcia Sanchez MS, Gomez Centeno P, Rosen E, et al; Milia en plaque in a bilateral submandibular distribution. Clin Exp Dermatol. 1998 Sep;23(5):227-9.
- Smith MA; Localized milia formation on pinna due to topical steroid application. Clin Exp Dermatol. 1977 Sep;2(3):285-6.
- Batra P, Tsou HC, Warycha M, et al; Multiple eruptive milia. Dermatol Online J. 2009 Aug 15;15(8):20.
- Bryden AM, Ferguson J, Ibbotson SH; Milia complicating photocontact allergy to absorbent sunscreen chemicals. Clin Exp Dermatol. 2003 Nov;28(6):668-9.
- Thami GP, Kaur S, Kanwar AJ; Surgical Pearl: Enucleation of milia with a disposable hypodermic needle. J Am Acad Dermatol. 2002 Oct;47(4):602-3.
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.
|Original Author: Dr Hayley Willacy, Dr Olivia Scott||Current Version: Dr Colin Tidy||Peer Reviewer: Dr Huw Thomas|
|Last Checked: 19/08/2011||Document ID: 4061 Version: 24||© EMIS|