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Milium

A milium is a small, superficial, keratin-filled cyst. Most patients present with multiple cysts and are thus diagnosed with milia.


Presentation

Milia are off-white or pearly, superficial lesions that generally measure less than 3 mm in diameter [5]. They are slightly raised above the skin surface.

With regards to the single entities, the following shall be stated:

  • Congenital milia may indicate more severe pathologies, e.g., Bazex-Dupré-Christol syndrome, Brooke–Spiegler syndrome, oral-facial-digital syndrome type I, pachyonychia congenita [3] [6]. Accordingly, neonates may present with the respective developmental defects.
  • Many neonates develop primary milia not associated with hereditary disorders [3] [7]. There are usually multiple lesions around the nose and in other facial areas, but the neonate's trunk and extremities may also be affected. Spontaneous remission is to be expected.
  • Juvenile and adult milia largely resemble those observed in neonates and are very common. However, the condition is usually more persistent and it may take longer until spontaneous remission occurs. Predilection sites are periorbital regions, cheeks, nose, forehead and chest.
  • Individuals affected by milia en plaque present with multiple milia grouped on an erythematous plaque [8]. Patients suffering from discoid lupus erythematosus, lichen planus, or pseudoxanthoma elasticum have been suggested to be predisposed to this type of milia. Milia en plaque commonly manifest in the head and neck region, especially in periauricular, periorbital and nose areas.
  • Multiple eruptive milia may be diagnosed if patients report the unexplained appearance of crops of milia within a short period of time [9]. Head, neck, and trunk are most frequently affected.
Amyloidosis
  • Nodular amyloidosis is a primary cutaneous amyloidosis characterized by the deposition of amyloid L-type fibril proteins in the dermis.[ncbi.nlm.nih.gov]
Italian
  • Abstract A 7-year-old Italian girl with juvenile colloid milium was studied with histological, immunohistochemical, and electron microscopic methods.[ncbi.nlm.nih.gov]
  • Look up "milium" at Merriam-Webster Look up "milium" at dictionary.com In other languages: Spanish French Italian Portuguese Romanian German Dutch Swedish Russian Polish Czech Greek Turkish Chinese Japanese Korean Arabic Advertisements Word of the day[wordreference.com]
Muscle Weakness
  • ‘Porphyria cutanea tarda presents as bullae, vesicles, and milia on the dorsal hands and forearms but does not cause muscle weakness.’[oxforddictionaries.com]
Eruptions
  • Multiple eruptive milia may be diagnosed if patients report the unexplained appearance of crops of milia within a short period of time. Head, neck, and trunk are most frequently affected. Milia are diagnosed clinically.[symptoma.com]
  • A common method that a dermatologist will use to remove a milium is to nick the skin with a #11 surgical blade and then use a comedone extractor to press the cyst out. [4] See also [ edit ] Eruptive vellus hair cyst Sebaceous hyperplasia Seborrheic keratosis[en.wikipedia.org]
  • Multiple eruptive milia Crops of numerous milia appear over a few weeks to months. Lesions may be asymptomatic or itchy. Most often affect the face, upper arms and upper trunk. Traumatic milia Occur at the site of injury as the skin heals.[dermnetnz.org]
  • Multiple eruptive milia presents as groups of numerous lesions which form over a long period, which may be accompanied by itching. These lesion groups typically appear on the upper arms, face, or upper torso.[ozarkderm.com]
Stroke
  • We describe three patients with colloid milium whose lesions showed purpura upon stroking. Two of these patients had juvenile colloid milium and the third had adult colloid milium.[ncbi.nlm.nih.gov]
  • Stroking may induce purpura in the lesions of colloid millium. Usually there is no associated systemic abnormality [ 10 ].[escholarship.org]

Workup

Milia are diagnosed clinically. A small incision into the lesion allows for the expression of keratinous material, which confirms the established visual diagnosis [10]. Although not usually required, tissue samples may be obtained for histopathological analyses. Microscopically, milia correspond to epidermal, keratin-filled cysts delimited by several layers of stratified squamous epithelium. These cysts originate in the infundibulum of the hair follicle. In the case of milia en plaque, immune cell infiltrates can be observed in close proximity to milia [8].

Treatment

  • Although little benefit could be seen after the first and second treatments, the patient showed clear improvement after the third treatment.[jamanetwork.com]
  • When this disorder affects the face, disfiguring is of great concern and treatment is often sought. Attempts to safely remove colloid milium are generally unsuccessful. Dermabrasion has been reported to be effective.[ncbi.nlm.nih.gov]
  • Treatment There is no treatment necessary for most cases of milia as they usually clear up on their own.[metrin.com]
  • Treatment *Treatment is generally not required, as the condition is benign *When treatment is required, destruction is the most common *In cases where lesions are widespread, other therapies may be recommended Milia do not typically require treatment,[ozarkderm.com]

Prognosis

  • […] milium is rare, and we report this case to increase knowledge and management regarding this rare disease and to differentiate it from other diseases such as amyloidosis, lipoid proteinosis, plasmacytoma, and conjunctival lymphoma, which carry a graver prognosis[ncbi.nlm.nih.gov]
  • […] definition, distribution, risk factors, causes, signs & symptoms, diagnosis, complications, treatment, prevention, prognosis, and additional useful information HERE .[dovemed.com]
  • Prognosis Colloid milium lesions remain static and do not resolve. Lesions reach their peak within 3 years, after which very few new papules occur. Patient Education Genetic counseling is advisable for the rare juvenile form of colloid milium.[emedicine.medscape.com]

Etiology

  • CONCLUSION: The etiologic significance of this condition is unknown. Potential sources of the material and a discussion of the differential diagnosis follow.[ncbi.nlm.nih.gov]
  • Although they are very common, evidence regarding their etiology and pathogenesis is scarce. This particularly applies to primary milia, which arise spontaneously.[symptoma.com]
  • Several etiologies have been postulated including chronic exposure to UV light, contact with petroleum products, application of bleaching creams containing hydroquinone, and genetic predisposition [ 1 ].[escholarship.org]
  • […] hyperpigmented. 2 The male-female ratio is 4:1. 4 Colloid milium, which was first described in 1866, was thought to be a result of the degeneration of sebaceous glands. 2 Although multiple theories have been proposed regarding the pathogenesis of CM, the exact etiology[jamanetwork.com]
  • Etiology Possible risk factors have been identified, but the origin and mechanism of pathogenesis remain unclear. For the adult and nodular forms, unprotected and prolonged UV exposure is likely responsible for the skin degeneration.[dermatologyadvisor.com]

Epidemiology

  • Epidemiology Frequency Colloid milium is rare, but more than 100 case reports are present in the world literature. No known figures exist on prevalence. Race Colloid milium is more common in fair-skinned individuals.[emedicine.medscape.com]
  • Primary: spontaneous Secondary: secondary to trauma, medications, or another disease Milia en plaque—rare type of primary milia which typically occurs in the posterior auricular area as an erythematous plaque Epidemiology Congenital milia is the most[unboundmedicine.com]
Sex distribution
Age distribution

Pathophysiology

  • The 4 variants are (1) an adult-onset type, (2) a nodular form (nodular colloid degeneration), [1] (3) a juvenile form, [2, 3] and (4) a pigmented form, thought to be due to excess hydroquinone use for skin bleaching. [4] Pathophysiology Colloid milium[emedicine.medscape.com]
  • Pathophysiology The most established theory argues that the colloid deposits are secondary to elastic fiber degeneration.[dermatologyadvisor.com]

Prevention

  • Hence, the occurrence of these cysts cannot be frequently prevented Milia may not require any treatment in most cases. Also, in a majority of individuals, it may disappear spontaneously on its own.[dovemed.com]
  • Some causes, of course, are more preventable than others. For one thing, putting heavy, occlusive products on your skin can coat the skin and inhibit the natural removal of dead skin cells.[theprettypimple.com]
  • Prevention Regular exfoliation helps avoid more aggressive forms of milia. A regular, daily skin care routine that incorporates gentle exfoliation will help avoid adult milia.[metrin.com]
  • Protection from the sun and petroleum derivatives is advised, but whether these precautions are actually preventive is still unclear. No follow-up is needed and it is not yet determined if maintenance therapy is required once successfully treated.[dermatologyadvisor.com]

Summary

A milium is a single, superficial, keratin-filled cyst. However, few patients present with solitary lesions and thus, research papers and case reports usually refer to milia. Besides cosmetic issues, milia are benign and not known to be associated with morbidity and mortality. Although they are very common, evidence regarding their etiology and pathogenesis is scarce. This particularly applies to primary milia, which arise spontaneously. In contrast, secondary milia develop after trauma, on sunburned skin, or sites affected by dermatological conditions related to the presence of blisters and bullae. The topical application of corticosteroids has also been related to the onset of milia [1]. Milia have been reported to develop after radiotherapy [2].

The following types of milia may be distinguished:

  • Congenital milia
  • Neonatal, juvenile, and adult-onset milia
  • Milia en plaque
  • Multiple eruptive milia
  • Trauma-associated milia

Of note, Epstein pearls and Bohn's nodules, i.e., gingival and palatal cysts, display certain similarities to milia and have repeatedly been referred to as the oral counterparts of the cutaneous condition. However, Spanish researchers could not confirm the association between the respective disorders [3] and they should be treated as individual entities [4].

References

Article

  1. Tsuji T, Kadoya A, Tanaka R, Kono T, Hamada T. Milia induced by corticosteroids. Arch Dermatol. 1986;122(2):139-140.
  2. Lee A, Griffiths WA. Multiple milia due to radiotherapy. J Dermatolog Treat. 2002;13(3):147-149.
  3. Monteagudo B, Labandeira J, Cabanillas M, Acevedo A, Leon-Muinos E, Toribio J. Prevalence of milia and palatal and gingival cysts in Spanish newborns. Pediatr Dermatol. 2012;29(3):301-305.
  4. Lewis DM. Bohn's nodules, Epstein's pearls, and gingival cysts of the newborn: a new etiology and classification. J Okla Dent Assoc. 2010;101(3):32-33.
  5. Berk DR, Bayliss SJ. Milia: a review and classification. J Am Acad Dermatol. 2008;59(6):1050-1063.
  6. Rutter KJ, Judge MR. Profuse congenital milia in a family. Pediatr Dermatol. 2009;26(1):62-64.
  7. Kansal NK, Agarwal S. Neonatal milia. Indian Pediatr. 2015;52(8):723-724.
  8. Terui H, Hashimoto A, Yamasaki K, Aiba S. Milia En Plaque as a Distinct Follicular Hamartoma With Cystic Trichoepitheliomatous Features. Am J Dermatopathol. 2016;38(3):212-217.
  9. Gonul M, Benar H, Gokce A. Multiple eruptive milia on scalp. J Eur Acad Dermatol Venereol. 2015.
  10. Zuber TJ. Minimal excision technique for epidermoid (sebaceous) cysts. Am Fam Physician. 2002;65(7):1409-1412, 1417-1408, 1420.

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Last updated: 2019-07-11 22:54