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Milia

Milia are very common, benign, keratin-filled cysts that occur in persons of all ages, from infants to elderly persons.

  • Primary milia are typically seen in infants but also may occur in children and adults.
  • Secondary milia are observed in a number of blistering disorders and following dermabrasion.
  • Milia en plaque and multiple eruptive milia are distinct entities.
Pathogenesis

They are tiny epidermoid cysts. The cysts may be derived from the pilosebaceous follicle. Primary milia arise on facial skin bearing vellus hair follicles. Secondary milia result from damage to the pilosebaceous unit.
They occur spontaneously or following subepidermal blistering e.g. after burns or a blistering disease.1No racial predilection is recognised and sexual prevalence is equal.

Presentation

Milia are superficial, uniform, pearly white to yellowish, domed lesions measuring 1-2 mm in diameter. Primary milia, in term infants, occur on the face, especially the cheeks, nose and eyes.

MILIA -NEAR EYE (DIS71.jpg)


They also may be found on the mucosa and palate. Palatal lesions are known as Epstein pearls.
Primary milia in older children and adults develop on the face, particularly around the eyes. Closed comedones are more cream than white and usually have a small punctum as well as being associated with open (black) comedones.
In milia en plaque, the small papules arise on a distinct, erythematous plaque in the postauricular area, unilaterally or bilaterally. Submandibular plaques and lesions on the pinna have been reported.2,3

Diagnosis

The clinical appearance is diagnostic in simple milia and no further investigations are required.
If milia en plaque is suspected, a biopsy is prudent to exclude the differential diagnoses.

Differential Diagnosis4
  • Acne Vulgaris
  • Syringoma
  • Trichoepithelioma
  • Lichen planus follicularis tumidus
  • Follicular mucinosis.
Primary Care Management

Often no treatment is required.
Some milia may be removed with a needle as they often shell out easily.5Topical peeling agents do not work.

Prognosis

Harmless, but unsightly.

When to Refer

For confirmation of diagnosis or reassurance.

Document references
  1. Bryden AM, Ferguson J, Ibbotson SH; Milia complicating photocontact allergy to absorbent sunscreen chemicals. Clin Exp Dermatol. 2003 Nov;28(6):668-9.
  2. 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. [abstract]
  3. Smith MA; Localized milia formation on pinna due to topical steroid application. Clin Exp Dermatol. 1977 Sep;2(3):285-6.
  4. Cooper S, Ratnavel R; Milia. eMedicine, July 2005.
  5. 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.
Acknowledgements EMIS is grateful to Dr Hayley Willacy for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2008.
DocID: 4061
Document Version: 22
DocRef: bgp25993
Last Updated: 19 Mar 2007
Review Date: 18 Mar 2009
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