Milia are benign, self-limited lesions that manifest as tiny white bumps on the forehead, nose, upper lip, and cheeks of the newborn.

Pathophysiology

Milia is observed as small multiple cysts ranging from 1-2 mm in diameter. Histologically, these cysts are multiple superficial inclusion cysts that involve the follicular infundibulum (upper part of the hair follicle). They contain keratin and surrounded by a dense lymphocytic infiltrate. No visible opening is present.

Age of Onset

Rash appears in neonates 1-2 days after birth. It can be delayed for days to weeks in neonates born prematurely.

Clinical Presentation

The milia lesions range from 1-2 mm in size and are papular. They are pearly opalescent lesions and mostly present on the face. These lesions are called Epstein pearls when present on the soft or hard palate.

Management

Most of the milia lesions disappear in infants by age 1-2 months. Application of creams or ointments is not recommended.

Milia is not infectious and is noncommunicable. No isolation or restriction of activity is required.

Prognosis is excellent because milia is a benign self-limiting rash. Milial lesions disappear in a few days without leaving any scars.

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