Basics
Description
- Common benign, keratin-filled cysts that present as white pinpoint papules most typically on the face but may occur elsewhere on the body (palate, gingiva, penis)
- Subtypes include primary and secondary milia.
- Primary: spontaneous
- Secondary: secondary to trauma, medications, or another disease
- Milia en plaque " rare type of primary milia which typically occurs in the posterior auricular area as an erythematous plaque
Epidemiology
- Congenital milia is the most common form of primary milia.
- Approx. 40% of newborns have milia.
- Less common in premature infants
- No gender or racial predilection
- Secondary milia can occur in all age groups.
Risk Factors
- Full-term newborns
- Any bullous condition increases the risk of secondary milia, particularly epidermolysis bullosa and porphyria.
Genetics
- No known genetic predisposition for primary congenital milia, the most common type of milia encountered in pediatrics
- Milia may be a major feature of rare genetic diseases of the skin (Loeys-Dietz syndrome, oral-facial-digital syndrome type 1, Rombo syndrome, or Bazex-Dupre-Christol syndrome).
General Prevention
There are no known preventative measures for primary milia.
Pathophysiology
- Retention of keratin and sebaceous material within the pilosebaceous duct, eccrine sweat duct, or sebaceous collar surrounding fine vellus hair
Etiology
- Most commonly spontaneous in newborns
- May be related to trauma or blistering conditions in older children
Diagnosis
History
- Primary congenital milia
- Asymptomatic
- Typically present at birth or in the first few days of life
- Secondary milia
- Recent trauma or burns
- History of blistering diseases
Physical Exam
- 1 " 2 mm pinpoint, white, pearly smooth papules without surrounding erythema or inflammation
- Distribution is most often on nose, cheeks, chin, and forehead in congenital milia.
- Other places to consider
- Oral mucosa: Epstein pearls on midline palate, Bohn nodules at gum margins
- Glans penis cysts
Diagnostic Tests & Interpretation
Diagnostic Procedures/Other
The diagnosis of milia can be made by history and physical exam alone. No further diagnostic testing is needed.
Differential Diagnosis
Other considerations in the newborn period are as follows:
- Sebaceous gland hyperplasia: secondary to exposure to maternal hormones. Lesions are yellowish, follicular papules typically on nose, cheeks, upper lip, and forehead.
- Neonatal acne: inflammatory, erythematous, papulopustular rash on the face and scalp; usually appears after 1 " 2 weeks of life, although it may be present at birth
- Erythema toxicum: benign rash in the neonatal period. It is characterized by erythematous macules, often with a central pustule or vesicle.
Treatment
- Primary congenital milia require no treatment. Milia are benign, asymptomatic, and self-limiting in this condition.
- Treatment may be indicated in the following settings:
- Diffuse or persistent milia in older children
- Milia in areas of trauma or burn leading to cosmetic concern
- Treatment could include topical retinoid or manual extraction.
Ongoing Care
Follow-up Recommendations
No specific monitoring or follow-up is necessary in congenital milia.
Prognosis
- Natural history of primary congenital milia is that the majority of cases will resolve spontaneously within 2 " 4 weeks without scarring or recurrence.
- In infants or children with diffuse or persistent milia, consider further evaluation for genodermatoses. Such conditions include Loeys-Dietz syndrome, oral-facial-digital syndrome type 1, Rombo syndrome, or Bazex-Dupre-Christol syndrome.
Complications
- Cosmetic concerns based on location of milia are usually the only complicating factor.
Additional Reading
- Berk DR, Bayliss SJ. Milia: a review and classification. J Am Acad Dermatol. 2008;59(6):1050 " 1063. [View Abstract]
- Leong T, Torres A, Macknet KD Jr, et al. Pronounced secondary milia precipitated by a superficial traumatic abrasion in a 4-year-old boy. J Pediatr. 2010;156(5):854. [View Abstract]
- Link to images
- Aby J. Photo gallery, professional education. Stanford School of Medicine Newborn Nursery at Lucille Packard Children 's Hospital Web site. http://newborns.stanford.edu/PhotoGallery/Milia1.html. Published 2013. Accessed February 14, 2015.
Codes
ICD09
- 704.8 Other specified diseases of hair and hair follicles
- 701.1 Keratoderma, acquired
- 528.4 Cysts of oral soft tissues
- 706.2 Sebaceous cyst
ICD10
- L70.2 Acne varioliformis
- L85.1 Acquired keratosis [keratoderma] palmaris et plantaris
- K09.8 Other cysts of oral region, not elsewhere classified
- L72.3 Sebaceous cyst
SNOMED
- 254679001 Milia (disorder)
- 254680003 Primary milia (disorder)
- 414116002 Epstein 's pearl of palate (disorder)
- 254681004 Secondary milia (disorder)
FAQ
- Q: Are milia painful or pruritic?
- A: No. Milia are asymptomatic. If there is pain, pruritus, fever, or other constitutional symptoms, the diagnosis of milia should be reconsidered.
- Q: Are milia contagious?
- A: No, they are not transmitted from person to person. In the case of congenital milia of the newborn, the parent should be reassured that the lesions are not infectious.
- Q: Are milia and miliaria the same condition?
- A: No. Both are benign skin conditions of childhood. However, miliaria is a disorder of the eccrine sweat glands, not of the pilosebaceous duct. Miliaria is characterized by sweat retention and subsequent vesicle formation, usually after prolonged perspiration. Miliaria is thought to occur because of sweat duct obstruction.