Milium, milia

Author: Monisha Gupta FACD, Dermatologist, Sydney, Australia; Amanda Oakley FRACP, Dermatologist, Hamilton, New Zealand, 2009.

What are milia?

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.

Clinical features of milia

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.

Classification of milia
Neonatal milia
  • Affect 40-50% of newborn babies
  • Few to numerous lesions
  • Often seen on the nose, but may also arise inside the mouth on the mucosa (Epstein pearls) or palate (Bohn nodules) or more widely on scalp, face and upper trunk
  • Heal spontaneously within a few weeks of birth.
Primary milia in children and adults
  • Found around eyelids, cheeks, forehead and genitalia
  • In young children, a row of milia may appear along the nasal crease
  • May clear in a few weeks or persist for months or longer
Juvenile milia Milia associated with epidermolysis bullosa
Milia en plaque Milia en plaque
Multiple eruptive milia
  • Crops of numerous milia appear over a few weeks to months
  • Lesions may be asymptomatic or itchy
  • Most often affect face, upper arms and upper trunk
Traumatic milia Milia
Associated with drugs Milia after fluorouracil cream

See more images of milia ...

How is the diagnosis made?

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.

They should also be distinguished from milia-like cysts noted on dermoscopy in seborrhoeic keratoses, papillomatous moles and some basal cell carcinomas.


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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