Milia

Major points
• Occurs in up to 40% of infants, most commonly
on the face
• Known as Epstein’s pearls when they occur in the
oral cavity; affect up to 85% of newborns
• 1–2mm white, firm papules on the face, but can
also occur on the trunk, extremities, genitalia and
oral mucosa (Figure 2.4)
• Can occur at sites of scars
Pathogenesis
• Keratinous cyst originating from vellus hair follicle
• Results from retention of keratin within the lowest
portion of the infundibulum of the pilosebaceous
unit at the level of the sebaceous duct
Diagnosis
• Clinical findings
• Histology: identical to epidermal cysts except for
smaller size; lined by stratified epithelium; contains
laminated keratin
Differential diagnosis
• Neonatal acne
• Sebaceous hyperplasia
• Molluscum contagiosum
Treatment
• No intervention required
• Incision and expression rarely required
Neonatal dermatology 11
Figure 2.4 Milia – multiple white papules on the face
Prognosis
• Typically resolves within weeks to months
• Can be associated with syndromes: type I
oral–facial–digital syndrome, hereditary
trichodysplasia, pachyonychia congenita
References
Akinduro OM, Burge SM. Congenital milia in the nasal
groove. Br J Dermatol 1994; 130: 800
Bridges AG, Lucky AW, Haney G, Mutasim DF. Milia en
plaque of the eyelids in childhood: case report and review of
the literature. Pediatr Dermatol 1998; 15: 282–4
Langley RG, Walsh NM, Ross JB. Multiple eruptive milia:
report of a case, review of the literature, and a classification.
J Am Acad Dermatol 1997; 37: 353–6
Larralde de Luna M, Paspa ML, Ibargoyen J.
Oral–facial–digital type I syndrome of Papillon-Leage and
Psaume. Pediatr Dermatol 1992; 9: 52–6
Stefanidou MP, Panayotides JG, Tosca AD. Milia en plaque:
a case report and review of the literature. Dermatol Surg
2002; 28: 291–5