Milium (plural milia)

A milium refers to a small cyst that contains a skin protein called keratin. Usually, milium is found in clusters and together they are known as milia. These cysts are considered to be harmless and appear as pearly-white bumps just under the surface of the skin.

Milia have no prevalence in age and sex; everyone has equal chances of developing this skin condition. Usually, they arise on face, especially on eyelids and cheeks.

There are different types of milia, which will be discussed further.

The neonatal milia affects 40-50% of newborn babies. The occurrence of lesions varies. They are usually found on nose, but can be found inside the mouth on the mucosa or palate, face, upper trunk, or scalp. The healing times takes few weeks.

The primary milia in children and adults is found on forehead, cheeks, and genitalia. In young children, milia can also arise on the nasal crease. The healing time can take from few weeks to months.

The juvenile milia can be either congenital (present at birth) or appear later in life. This particular type of milia is associated with Bazex-Dupre-Christol syndrome, Gardner syndrome, basal cell naevus syndrome, and other genetic disorders.

Milia en plaque is usually found behind the ear, cheek, jaw, or eyelid. It affects both children and adults, especially middle-aged women.

Multiple eruptive milia usually affect face, upper trunk, and upper arms. These lesions can either be asymptomatic or itchy.

The traumatic milia usually arises from eccrine sweat ducts. It occurs at the site of injury when the healing process begins. The examples of injuries include blistering rashes, dermabrasion or thermal burns.

Milia associated with drugs can be caused from hydroquinone, corticosteroid, and phenols.

Milia have a defined appearance. Sometimes a skin biopsy can be performed for clarification of diagnosis. Milia should not be confused with camedones, syringomas, and cysts. Colloid milia have a clinical feature of golden coloured bumps that appear on temples and cheeks caused from excessive sunlight exposure.

Milia do not require any treatment unless they appear concerning for the patient. They usually can heal by themselves within a few months. However, the further trauma needs to be minimized in order to prevent the development of new lesions in the future.

The lesion can be de-roofed via sterile needle or blade; all the content will be pricked out or squeezed. These lesions can also be destroyed by cryotherapy, curettage or diathermy. For the widespread lesions, the topical retinoids can be helpful. Cosmetic procedures like chemical peels, dermabrasion, and laser ablation show successful results.

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