You are in: eMedicine Specialties > Pediatrics: General Medicine > Dermatology MiliaArticle Last Updated: Mar 27, 2006AUTHOR AND EDITOR INFORMATIONSection 1 of 9
  Author: Ruchir Agrawal, MD, Consulting Staff, Allergy Specialists MD SC, Children's Hospital of Wisconsin Ruchir Agrawal is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American College of Allergy, Asthma and Immunology, and American Medical Association Editors: Kevin P Connelly, DO, Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University; Medical Director, Paws for Health Pet Visitation Program; Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc; Robert A Schwartz, MD, MPH, Professor and Head of Dermatology, Professor of Medicine, Professor of Pediatrics, Professor of Pathology, Professor of Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School; Merrily P M Poth, MD, Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences; Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center Author and Editor Disclosure Synonyms and related keywords: milia, neonatal rash, Epstein pearls, inclusion cysts INTRODUCTIONSection 2 of 9
  BackgroundMilia is a benign, self-limiting rash that manifests as tiny white bumps on the forehead, nose, upper lip, and cheeks of the newborn. PathophysiologyMilia is observed as small multiple cysts ranging from 1-2 mm in diameter. Histologically, these cysts are multiple superficial inclusion cysts containing keratin and surrounded by a dense lymphocytic infiltrate. No visible opening is present. FrequencyUnited StatesApproximately 40% of newborn infants develop milia. This condition is mainly associated with newborns carried to full term or nearly to term. Typically, the rash appears after 4-5 days in full-term newborns. Infants born prematurely are less commonly affected. Manifestations of milia may be delayed from days to weeks in infants born before term. RaceNo racial predilection is observed. SexNo sexual predilection exists. AgeRash appears in neonates 1-2 days after birth. It can be delayed for days to weeks in neonates born prematurely. CLINICALSection 3 of 9
PhysicalThe 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. DIFFERENTIALSSection 4 of 9
Erythema Toxicum Herpes Simplex Virus Infection Neonatal Pustular Melanosis
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