MiliaL72.8

Epithelial cysts up to the size of a pinhead, filled with whitish horny beads (colloquially: skin gravel) without open connection to the skin surface. Milia are usually perceived as a cosmetic problem. Multiple milia can occur in the context of genodermatoses.

• Primary milia: develop spontaneously from interfollicular epidermis, vellus hair follicles or in excretory ducts of eccrine sweat glands.
  • Milia of the infant
  • Milia as partial manifestations of different syndromes. syndromes (see Gorlin-Goltz syndrome, Brooke-Spiegler syndrome, nevoid basal cell carcinoma syndrome, Bazex-Dupre-Crhistol syndrome, Rombo syndrome).
  • Multiple eruptive milia : genodermatosis - autosomal dominant inheritance(?); acquired mainly as a side effect of therapy with tyrosine kinase inhibitors.
  • Milia en plaque
• Secondary milia: e.g. after bullous dermatoses or posttraumatic by displacement of keratinizing epithelial sections under the epidermis (e.g. after burns, abrasions, etc.).
  • Secondary milia: in actinically damaged skin
• Pseudomilia: Clinically appearing as milia, whitish papules caused by deposition of oxalates in the skin (see oxalosis).

• Primary milia: Develop spontaneously from interfollicular epidermis, vellus hair follicles or in excretory ducts of eccrine sweat glands (classical etiology in infants).
• Milia are also seen as partial manifestations of various genodermatoses. (see Gorlin-Goltz syndrome, ectodermal dysplasia, Brooke-Spiegeler syndrome, nevoid basal cell carcinoma syndrome, Bazex-Dupre-Crhistol syndrome, Rombo syndrome).
• Secondary milia: e.g. after bullous dermatoses or posttraumatic due to displacement of keratinizing epithelial sections under the epidermis (e.g. after burns, abrasions, etc.).
• Pseudomilia: Clinically appearing as milia, whitish papules caused by deposits of oxalates in the skin (see oxalosis below).

• Occurs in young adults, especially in women.
• Milia are frequent, transient skin symptoms in newborns and infants during the 1st year of life (in about 50%) see below. Milia eruptive.

Primary milia: V.a. on the face: lateral cheeks, periorbital, temples.

Secondary milia: often after bullous dermatoses or posttraumatic. Thus, the localization depends on the occurrence of the primary lesions.

Multiple, disseminated, 0.1-0.4 cm large, spherical, yellowish-white, granular nodules, clearly demarcated from the surroundings, very superficially located in the skin. Post-lesional or post-traumatic milia often occur as small white, rough, grouped, symptomless (often accidental observation) nodules in the previously affected area.

Horn-filled, smallest epithelial cysts that are bound to a vellus hair follicle or to the acrosyringium.

Xanthelasma: Occurrence typically in the area of the eyelids. Usually clearly larger than 0.1-0.3 cm. Soft consistency!

Miliaria: Mostly acute onset after exposure to heat; usually pruritus, which is always absent in eruptive milia.

Hyperplasia of the sebaceous glands in infants: Typical localization is the bridge of the nose and cheeks (milia tend to be on the forehead, chin region possibly eyelid area).

Acne neonatorum: Typical picture of acne with closed and open comedones. Also inflammatory papules and pustules (signs of inflammation are always absent in milia!).

Colloid milium: Rare disease, glass pinhead-sized, transparent appearing, soft, grouped papules. In adult forms, occurrence in combination with other actinic changes.

1. Dogra S et al (2002) Milia en plaque in a renal transplant patient: a rare presentation. Int J Dermatol 41: 897-898
2. Dogra S, Kanwar A (2005) Milia en plaque. J Eur Acad Dermatol Venereol 19: 263-264
3. Eckman JA et al (2002) Bullous systemic lupus erythematosus with milia and calcinosis. Cutis 70: 31-34
4. Gallardo Avila PP et al (2021) Milia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. PMID: 32809316
5. Kalayciyan A et al. (2004) Milia in regressing plaques of mycosis fungoides: provoked by topical nitrogen mustard or not? Int J Dermatol 43: 953-956
6. Kouba DJ et al (2003) Milia en plaque: a novel manifestation of chronic cutaneous lupus erythematosus. Br J Dermatol 149: 424-426
7. Lee A et al (2002) Multiple milia due to radiotherapy. J Dermatolog Treat 13: 147-149
8. Stefanidou MP et al (2002) Milia en plaque: a case report and review of the literature. Dermatol Surg 28: 291-295
9. Thami GP et al (2002) Surgical Pearl: enucleation of milia with a disposable hypodermic needle. J Am Acad Dermatol 47: 602-603