Milia (overview) L72.8

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Grains of semolina of the skin; milia (nicht Miliaria!); Militia; Milium; Skin grits; Skinmilia; Skin Semolina

Definition
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Up to pinhead-sized epithelial cysts filled with whitish horny pearls (colloquially: skin grits) without open connection to the skin surface. Milia are usually perceived as a cosmetic problem.

Classification
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  • Primary milia: development spontaneously from interfollicular epidermis, vellus hair follicles or in the ducts of eccrine sweat glands
  • Secondary milia: e.g. after bullous dermatoses or post-traumatically by relocation of cornified epithelial sections under the epidermis (e.g. after burns, abrasions, etc.)
    • Secondary milia: in actinically damaged skin
  • Pseudomilia: Whitish papules clinically impressive as milia, caused by deposits of oxalates in the skin (see oxalosis below).

Etiopathogenesis
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  • Primary milia: development spontaneously from interfollicular epidermis, vellus hair follicles or in the ducts of eccrine sweat glands (classical etiology in infants).
  • Milia are also seen as partial manifestations of various diseases. syndromes (see Gorlin-Goltz syndrome, ectodermal dysplasia).
  • Secondary milia: e.g. after bullous dermatoses or posttraumatically by relocation of keratinized epithelial sections under the epidermis (e.g. after burns, abrasions, etc.).
  • Pseudomilia: Whitish papules clinically impressive as milia, caused by deposits of oxalates in the skin (see oxalosis below).

Manifestation
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  • 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.

Localization
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  • Primary milia: Especially in the face: lateral cheeks, periorbital, at the temples.
  • Secondary milia: often after bullous dermatoses or post-traumatic. Their location depends on the presence of primary lesions.

Clinical features
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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.

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

Differential diagnosis
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  • Xanthelasma: Occurs typically in the region of the eyelids. Usually significantly larger than 0.1-0.3 cm. Soft consistency!
  • Miliaria: Mostly acute appearance after heat exposure; mostly itching, which is always absent in eruptive milia.
  • Hyperplasia of the sebaceous glands in infants: Typical localization are the bridge of the nose and the cheeks (milia rather on the forehead, chin region, possibly in the eyelid region).
  • Acne neonatorum: Typical picture of acne with closed and open comedones. Also inflammatory papules and pustules (signs of inflammation are always absent in milia!).
  • Colloidmilium: Rare disease, glass pinhead-sized, transparent, soft, grouped standing papules. In adult forms it occurs in combination with other actinic changes.

Therapy
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Scribing with a pointed, larger cannula, carefully expressing the contents. Alternatively, try therapy with local retinoids such as 0.05% tretinoin cream R256. The infant's milia are of a temporary nature, they spontaneously regress until the 3rd-6th week of life (inform mothers about harmlessness).

Progression/forecast
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Secondary milia: Spontaneous regression possible.

Literature
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  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. 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
  5. Kouba DJ et al (2003) Milia en plaque: a novel manifestation of chronic cutaneous lupus erythematosus. Br J Dermatol 149: 424-426
  6. Lee A et al (2002) Multiple milia due to radiotherapy. J Dermatologist Treat 13: 147-149
  7. Stefanidou MP et al (2002) Milia en plaque: a case report and review of the literature. Dermatol Surgery 28: 291-295
  8. Thami GP et al (2002) Surgical Pearl: Enucleation of milia with a disposable hypodermic needle. J Am Acad Dermatol 47: 602-603

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020