Milia

Milia (See also Chapter 30: Benign Cutaneous Neoplasms)

Lesions represent trapped keratin (the main structural protein in skin) just underneath the epidermis.

Appear as pinpoint (1- to 2-mm) white or yellow superficial papules typically located on the cheeks, nose, chin, or forehead (Fig. 2.10).
They may occur singly but more often present as multiple lesions or grouped.
Occur in 40% to 50% of newborns, and self-resolve within the first month of life.
Milia can also be seen in older children and adolescents on the face especially around the eyes or on the scrotum following trauma to the skin usually from scratching or rubbing (Fig. 2.11).

Differential Diagnosis

Sebaceous Hyperplasia (see above)

Yellow-white monomorphic, tiny papules typically grouped on the nose of a newborn.

Miliaria (see below)

Pinpoint vesicles and pustules with surrounding erythema grouped over trunk and occluded areas of skin.

Management

No treatment is necessary as most milia on newborns resolve spontaneously without scarring in the first few months of life.
Persistent milia or for milia in older children that are bothersome, lesions can be extracted manually by nicking the top of the lesion (with a lancet or an 11 blade) and manually removing contents, or using a comedone extractor to drain.
Topical retinoids such as tretinoin 0.025% cream has also been used to help clear persistent milia.