Colloidalmilium L57.8; L72.8

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 13.07.2024

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Synonym(s)

adult colloidal milium; Colloidal degeneration of the skin; colloidal milium; Degeneration of colloidal skin; elastosis colloidalis conglomerata; Hyalom; pseudomilium colloidale

History
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Wagner 1866

Definition
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Circumscribed connective tissue disorder with deposition of a "defective" scleroprotein (colloid) in the papilla tips of light-exposed skin areas.

Classification
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According to the age of manifestation, a distinction is made between the juvenile colloidal milium (see below colloidal milium, juveniles) and the classical colloidal milium of adults.

Manifestation
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  • Adult or solar form: more common form, especially in chronic light exposure or after contact with photosensitisers. Occurs in adulthood.
  • Juvenile form (rare): occurring before puberty. Autosomal dominant mode of inheritance.

Localization
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Exposed skin areas, especially the middle of the forehead, zygomatic arch, sides of the neck, ears, back of the hand, nose, upper lip, chin.

Clinical features
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Numerous glass pinhead-sized, transparent, exceptionally yellowish-brownish or skin-coloured, soft, grouped papules; after stab incision a jelly-like mass empties under pressure. In adult forms it occurs in combination with other actinic changes such as elastoidosis cutanea nodularis et cystica, cheilitis actinica, cutis rhomboidalis nuchae.

Histology
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Homogeneous, circumscribed, amophilic or basophilic, PAS-positive colloidal conglomerates in the upper dermis. The deposits are cell-poor. Typical are the preparation-related cracks and fissures within the colloid nodule. The overlying epithelium is flattened and atrophic. In the adult form, solar elastosis is obligatory, which is missing in the juvenile form. Versch. Investigators could stain the (keratin-)colloid with keratin-AK in the juvenile form (compare keratin-amlyoid in LIchen amyloidosus)

Indirect immunofluorescence
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Negative with antibody.

Differential diagnosis
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Therapy
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Diathermy, laser therapy with Erbium-YAG-Laser, curettage or cryosurgery. Experimental dermabrasion.

Note(s)
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Noteworthy is the reference to the concordant occurrence of beta-thalassaemia major and colloid milium (Giordano G et al. 2008).

Literature
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  1. Ammirati CT et al. (2002) Adult-onset facial colloid milium successfully treated with the long-pulsed Er:YAG laser. Dermatol Surg 28: 215-219
  2. Chowdhury MM et al. (2000) Juvenile colloid milium associated with ligneous conjunctivitis: report of a case and review of the literature. Clin Exp Dermatol 25: 138-140
  3. Giordano G et al. (2008) A case of colloid milium in patient with beta thalassaemia major. J Cutan Pathol 35:566-569.

  4. Kirtak N et al. (2002) A case of adult colloid milium with chronic sun exposure. Int J Dermatol 41: 936-938
  5. Lewis AT et al. (2002) Unilateral colloid milium of the arm. J Am Acad Dermatol 46(2 Suppl Case Reports): S5-7
  6. Muscardin LM et al (2000) Papuloverrucous colloid milium: an occupational variant. Br J Dermatol 143: 884-887
  7. Oskay T et al. (2003) Juvenile colloid milium associated with conjunctival and gingival involvement. J Am Acad Dermatol 49: 1185-1188
  8. Schuster V et al (2003) Ligneous conjunctivitis. Surv Ophthalmol 48: 369-388
  9. Schrallhammer-Benkler K et al (1990) Colloid milium. Dermatology 41: 451-454

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Last updated on: 13.07.2024