Saturday, June 15, 2024

Pediatric Milia

Background

Milia are benign, keratinous cysts that commonly manifest as tiny white bumps on the face of the newborn (see the image below). When present on the gum margin and midline palate they are referred to as Bohn nodules and Epstein pearls, respectively. Milia can be broadly categorized into primary and secondary types. Congenital milia in newborns account for the vast majority of primary milia. Primary milia may also occur in association with one of several genodermatoses or sporadically without associated findings. Secondary milia may be associated with an underlying skin disease, medications, or trauma.

Milia in a week old infant.

Milia in a week old infant.

See 13 Common-to-Rare Infant Skin Conditions, a Critical Images slideshow, to help identify rashes, birthmarks, and other skin conditions encountered in infants.

In 2008, Berk and Bayliss published an updated classification of milia, as follows
:

Primary milia is as follows:

Congenital

Benign primary milia of children and adults

Milia en plaque

Nodular grouped milia

Multiple eruptive milia

Nevus depigmentosus with milia

Genodermatosis-associated

Secondary milia is as follows:

Disease-associated

Medication-associated

Trauma-associated

Congenital milia occur in nearly half of healthy newborns and are typically present at birth, although their onset may be delayed in premature neonates.
Lesions typically spontaneously resolve within weeks. Congenital milia predominate on the face, and the nose is frequently affected.

Benign acquired milia of children and adults also occur spontaneously; however, like other acquired milia, they have a tendency to persist without treatment. Benign acquired milia of children and adults favor the eyelids, cheeks, forehead and genitalia.

Multiple eruptive milia describes acquired and widespread milia that appear rather abruptly over weeks to months. Multiple eruptive milia may be associated with a genodermatosis or inherited in an autosomal dominant fashion without other apparent anomalies; however, in most cases they occur sporadically.

Genodermatosis-associated milia have been reported in association with basal cell nevus syndrome,
Rombo syndrome,
Brooke-Spiegler syndrome,
pachyonychia congenita type 2,
and atrichia with papular lesions.

In children, traumatic milia most commonly manifest following abrasions or burns. Milia have also been reported following skin grafting.
Milia may occur in association with blistering skin diseases. Epidermolysis bullosa and porphyria cutanea tarda are the classic examples. Milia associated with topical corticosteroid use is rarely reported.

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