Skin disease in a child: Milia Flashcards
Define milia.
Common, benign, keratin-filled cysts.
- Primary milia are typically seen in infants but also may occur in children and adults.
- Secondary milia develop after trauma to the skin, such as after burns (e.g. sunburns), dermabrasion, or in blistering disorders.
- Milia en plaque is a rare inflammatory condition characterised by plaques of milia in the periauricular area.
- Multiple eruptive milia is a condition characterised by the sudden development of crops of milia over the course of weeks to months.
Explain the aetiology/risk factors for milia.
Milia are tiny epidermoid cysts. The cysts may be derived from the pilosebaceous follicle. Primary milia arise on facial skin bearing vellus hair follicles. Secondary milia result from damage to the pilosebaceous unit.
Summarise the epidemiology of milia.
Primary milia in newborns are so common that they can be considered normal (occurs in about 50% of all infants).
Multiple eruptive milia and milia en plaques are rare.
What are the symptoms of milia?
Milia are asymptomatic. In children and adults, they usually arise around the eye. Eruptive milia, as the name suggests, have a rapid onset, often within a few weeks.
What are signs of milia?
Skin lesions: Milia are superficial, uniform pearly white to yellowish, domed lesions measuring 1-2mm in diameter. In milia en plaque, multiple milia arise on an erythematous plaque.
Skin distribution: Primary milia, in term infants, occur on the face, especially the nose. They also may be found on the mucosa (Epstein pearls) and palate (Bohn nodules). Primary milia in older children and adults develop on the face, particularly around the eyes. Milia have been observed to occur in a transverse, linear distribution along the nasal groove in some children and around the areolae.
Secondary milia are found anywhere on the body at the sites affected by the predisposing condition.
Eruptive milia occur on the head, neck, and upper body. Milia en plaque manifests as distinct plaques on the head and neck. Plaques have been described in the postauricular area, unilaterally or bilaterally, the cheeks, the submandibular plaques, and on the pinna. A linear distribution has been described.
What are appropriate investigations for milia?
Clinical appearance is diagnostic. Biopsy if in doubt.
What is the management for milia?
No topical or systemic medications are effective on primary and secondary milia.
What are complications associated with milia?
No systemic complications have been reported.
What is the prognosis of milia?
Milia seen in infancy tend to spontaneously disappear within the first few weeks of life. Milia in older children and adults tend to persist. Secondary milia arising from blisters rarely resolve.
