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Milia
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Milia are very common, benign, keratin-filled 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.
- Secondary milia are observed in a number of blistering disorders and following dermabrasion.
- Milia en plaque and multiple eruptive milia are distinct entities.
These are tiny epidermoid cysts. The cysts may be derived from the pilosebaceous follicle. Primary milia arise on facial skin bearing vellus hair follicles. They are thought to be a manifestation of immature sebaceous glands. Secondary milia result from damage to the pilosebaceous unit. They occur spontaneously or following subepidermal blistering e.g. after burns or a blistering disease.2 They have also been known to occur after potent topical steroid use.1
- Primary milia in newborns are so common (approximately 50% of infants) as to be considered normal.
- Multiple eruptive milia and milia en plaque are rare entities.
- No racial predilection is recognised.
- Sexual prevalence is equal.
Milia are superficial, uniform, pearly-white to yellowish, domed lesions measuring 1-2 mm in diameter. They are asymptomatic.
Primary milia
Primary milia, in term infants, occur on the face, especially the cheeks, nose and eyes. In older children and adults, they also develop on the face, particularly around the eyes. They may also be found on the mucosa (Epstein pearls) and palate (Bohn nodules).1

Secondary milia
These are found anywhere on the body where there has been a predisposing condition.
Milia en plaque
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.3,4
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-Racouchet syndrome). If milia en plaque is suspected, a biopsy is prudent to exclude the differential diagnoses.
- Acne vulgaris
- Syringoma
- Trichoepithelioma
- 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.
- Often no treatment is required.
- Some milia may be removed with a needle as they often shell out easily.5
- Topical peeling agents do not work.
Harmless but unsightly. In the infant, they tend to resolve spontaneously but in older children and adults, they may persist, requiring removal with a needle (no anaesthetic is required).1
For confirmation of diagnosis or reassurance. It is worth referring patients with suspected milia en plaque.
Document references
- Cooper S; Milia. eMedicine, May 2008.
- Bryden AM, Ferguson J, Ibbotson SH; Milia complicating photocontact allergy to absorbent sunscreen chemicals. Clin Exp Dermatol. 2003 Nov;28(6):668-9.
- 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]
- Smith MA; Localized milia formation on pinna due to topical steroid application. Clin Exp Dermatol. 1977 Sep;2(3):285-6.
- 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.
Internet and further reading
- Berk DR, Bayliss SJ; Milia: a review and classification. J Am Acad Dermatol. 2008 Dec;59(6):1050-63. Epub 2008 Sep 25. [abstract]
Document ID: 4061
Document Version: 23
Document Reference: bgp25993
Last Updated: 24 Feb 2009
Planned Review: 24 Feb 2011
The authors and editors of this article are employed to create accurate and up to date content reflecting reliable research evidence, guidance and best clinical practice. They are free from any commercial conflicts of interest. Find out more about updating.
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