Author: Monisha Gupta FACD, Dermatologist, Sydney, Australia; Amanda Oakley FRACP, Dermatologist, Hamilton, New Zealand, 2009.
A milium is a small cyst containing keratin (skin protein); they are usually multiple and are then known as milia. These harmless cysts present as tiny pearly-white bumps just under the surface of the skin.
Milia are common in all ages and both sexes. They most often arise on the face, and are particularly prominent on the eyelids and cheeks, but they may occur elsewhere.
There are various kinds of milia.
1. Found around eyelids, cheeks, forehead and genitalia.
2. In young children, a row of milia may appear along the nasal crease.
3. May clear in a few weeks or persist for months or longer.
1. Associated with Rombo syndrome, basal cell naevus syndrome, Bazex-Dupre-Christol syndrome, pachyonychia congenita, Gardner syndrome and other genetic disorders
2. May be congenital (present at birth) or appear later in life.
1. Multiple milia appear on within an inflamed plaque up to several centimetres in diamater.
2. Usually found on eyelid, behind ears, on cheeks or jaw.
3. Affect children and adults, especially middle-aged women.
4. Sometimes associated with other skin disease including pseudoxanthoma elasticum, discoid lupus erythematosus, lichen planus.
1. Crops of numerous milia appear over a few weeks to months.
2. Lesions may be asymptomatic or itchy.
3. Most often affect face, upper arms and upper trunk.
1. Occur at site of injury as skin heals.
2. Arise from eccrine sweat ducts.
3. Examples include thermal burns, dermabrasion, blistering rashes such as bullous pemphigoid 4.Often seen on back of hands and fingers in porphyria cutanea tarda.
5. Milia-like calcified nodule may develop after neonatal heel stick blood test.
Milia have a characteristic appearance. However, on occasion, a skin biopsy may be performed. This shows a small epidermoid cyst coming from a vellus hair follicle.
Milia should be distinguished from other types of cyst, comedones, xanthelasma and syringomas. Colloid milia are golden coloured bumps on cheeks and temples associated with excessive exposure to sunlight.
Milia do not need to be treated unless they are a cause for concern for the patient. They often clear up by themselves within a few months. Where possible, further trauma should be minimised to reduce development of new lesions.
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