Author:

• Lauren Hosek

Faculty Reviewer:

• Adam Tinklepaugh

Publish date: Posted on March 7, 2021May 16, 2022
Last updated: May 16, 2022

Keywords #

milia(plural)
milium(singular)

Diagnosis #

Milia are small (<3 mm), benign, pale papules found commonly on the face in individuals of all ages. The papules are composed of firm subepidermal keratin cysts. The etiology of milia can be classified as primary (occurring spontaneously) or secondary (due to trauma, medications, or blistering skin disease).[1]

Key Concepts #

• Milia are benign and can result from either primary or secondary etiology.
• Milia are usually diagnosed clinically.
• Treatment includes observation and self-resolution, topical tretinoin, scalpel or comedone extraction, electrodessication, curettage, cauterization, or ablative laser therapy.

Epidemiology #

Congenital milia occur in 40-50% of newborns and usually resolve spontaneously within weeks to months.[1] Milia are most common in children but can be found in people of all ages.

Clinical Features #

• Milia appear as small, white/yellow, fixed, firm papules.
• The most common locations include cheeks, eyelids, forehead, and genitalia.[1]

Differential Diagnoses #

• Flat wart
• Syringoma
• Sebaceous hyperplasia
• Molluscum contagiosum
• Comedone
• Calcinosis cutis
• Trichoepithelioma
• Eruptive vellus hair cysts

Diagnostic Workup #

Milia are usually diagnosed clinically, however they will fluoresce bright yellow under Wood’s lamp at 396 nm in the case of diagnostic uncertainty.[2] Histologically, milia resemble epidermoid cysts with several layers of stratified squamous epithelium and central keratin material.[1]

Treatment #

Congenital milia often resolve within weeks to months without treatment. Persistent milia, as seen in adults, can be treated with topical tretinoin, scalpel or comedone extraction, electrodessication, curettage, cauterization, or ablative laser therapy.[1,3] Recurrence is uncommon.[4]

References #

1. Berk DR, Bayliss SJ. Milia: A review and classification. Journal of the American Academy of Dermatology. 2008;59(6):1050-1063.
2. Lee JH, Kwon HS, Jung HM, Kim GM, Bae JM. Wood’s lamp-induced fluorescence of milia. Journal of the American Academy of Dermatology. 2018;78(5):99-100.
3. Davis DS, Taylor MB. Successful treatment of milia in skin of color (FST IV-VI) with variable short-pulse Er:YAG laser vaporization. Dermatologic Surgery. 2019.
4. Connelly T. Eruptive milia and rapid response to topical tretinoin. Arch Dermatol. 2008;144(6):816-817.