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CASE REPORT
Year : 2018  |  Volume : 21  |  Issue : 3  |  Page : 395-396

Idiopathic multiple eruptive milia: Report of a case in a nigerian woman


Dermatology Unit, Department of Medicine, Barau Dikko Teaching Hospital, Kaduna, Nigeria

Date of Acceptance16-Oct-2017
Date of Web Publication09-Mar-2018

Correspondence Address:
Dr. H Yahya
Dermatology Unit, Department of Medicine, Barau Dikko Teaching Hospital, PO Box 9727, Kaduna
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_43_17

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   Abstract 


Milia are multiple, small, benign keratin-filled superficial epidermoid cysts which are classified as primary when they occur spontaneously or secondary when they result from skin trauma or disease. Multiple eruptive milia (MEM) refer to a condition characterized by a sudden eruption of a large number of milia. MEM may be familial, occur as part of a genodermatosis, or occur spontaneously when they are termed idiopathic. Idiopathic MEM are an exceedingly rare disease. We present the case of a 70-year-old Nigerian woman with idiopathic MEM.

Keywords: Idiopathic multiple eruptive milia, milia, multiple eruptive milia


How to cite this article:
Yahya H. Idiopathic multiple eruptive milia: Report of a case in a nigerian woman. Niger J Clin Pract 2018;21:395-6

How to cite this URL:
Yahya H. Idiopathic multiple eruptive milia: Report of a case in a nigerian woman. Niger J Clin Pract [serial online] 2018 [cited 2019 Nov 18];21:395-6. Available from: http://www.njcponline.com/text.asp?2018/21/3/395/226973




   Introduction Top


Milia are multiple, small (1–2 mm), benign, keratin-filled superficial epidermoid cysts derived from pilosebaceous apparatus or eccrine sweat ducts[1] and are classified as primary when they arise spontaneously or secondary when they result from skin trauma such as burns, dermabrasion and radiotherapy, subepidermal blistering skin disease, topical steroid (clobetasol propionate), or a systemic medication (cyclosporine).[2] Primary milia are very common and may affect up to 50% of neonates; they are also common in older children and adults when they occur around the eyes, on the cheeks and forehead.[2] Milia en plaque is a rare form of primary milia which occurs on an erythematous, edematous, or infiltrated base usually on periauricular and periorbital regions of adults.[3] Multiple eruptive milia (MEM) refer to a condition characterized by the sudden eruption of a large number of milia over a period of weeks to months and may arise spontaneously without any cause when it is described as idiopathic; it may also be familial or may be part of a genodermatosis.[4] Idiopathic MEM is a rare skin disease, and to date, only about 14 cases have been reported in the English language medical literature, and to the best of our knowledge, none has been reported from Africa. We report a case of idiopathic MEM in a Nigerian woman.


   Case Report Top


A 70-year-old woman presented with a 1-year history of multiple 1–2 mm skin-colored to yellowish dome-shaped firm, discrete, scattered, and on occasion, confluent papules on the forehead, glabella, and cheeks [Figure 1]. Lesions appeared rapidly over a few weeks, were asymptomatic, and were not preceded by any trauma or skin disease. There were no similar lesions elsewhere. There was no history of a similar condition in any family member. The patient was otherwise healthy and had no significant medical history. Histological examination of a 4-mm punch biopsy of a lesion showed multiple cysts lined by stratified squamous epithelium and containing eosinophilic concentric lamellae of keratin characteristic of milia [Figure 2]. The patient was prescribed tretinoin 0.05% cream but did not return for follow-up.
Figure 1: Clinical photograph of multiple eruptive milia on the face

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Figure 2: Photomicrograph shows multiple keratin-filled cysts lined by stratified squamous epithelium characteristic of milia (H and E, ×40)

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   Discussion Top


Idiopathic (spontaneous) MEM is an exceedingly rare disease, and to date, only about 14 cases have been reported in the English language medical literature. We believe that this is the first report of a case from Africa. The age of patients presenting with idiopathic MEM ranges from 9 to 91 years, and there seems to be no gender difference in the cases. Our patient's presentation is typical for idiopathic MEM. Lesions have also been reported to occur on other body parts such as the scalp, neck, upper chest, back, arms, shoulders, abdomen, and axillae.[5] The trigger for idiopathic MEM is unclear and suggested causes are speculative. Sun exposure has been proposed as an explanation for lesions on the face, neck, and shoulders, and scratching and rubbing is another suggested cause which may account for lesions on the covered parts of the body.[4],[5] Familial cases of MEM have been described and are believed to be transmitted in an autosomal dominant fashion.[2] MEM may also be associated with such genodermatoses as Rombo syndrome, basal-cell nevus syndrome, Bazex–Dupre–Christol syndrome, pachyonychia congenita, and Gardner syndrome.[2] The clinical differential diagnosis of MEM includes eruptive syringoma, miliaria crystallina, eruptive vellus hair cysts, and generalized milia-like idiopathic calcinosis cutis.[5] Physical treatments often used for milia such as expression of lesions, curettage, electrodessication, and cryotherapy may be unsuitable for idiopathic MEM because of the large number of lesions requiring treatment which may cause discomfort for the patient. Topical tretinoin cream has been successfully used to clear lesions in 6 weeks in one case[6] but not in another.[7] Although our patient was prescribed topical tretinoin, she did not return for follow-up, so we could not judge its success or otherwise. Milia en plaque has been successfully treated with oral etretinate[8] and it is possible that it can succeed in MEM as well. Pulse oral azithromycin has been used with great success in a patient.[9] Carbon dioxide and erbium:yttrium-aluminum-garnet lasers have been used with variable success.[5]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Patterson JW. Cysts, sinuses and pits. In: Weedon's Skin Pathology. 4th ed. London: Churchill Livingstone; 2016. p. 509-29.  Back to cited text no. 1
    
2.
Berk DR, Bayliss SJ. Milia: A review and classification. J Am Acad Dermatol 2008;59:1050-63.  Back to cited text no. 2
[PUBMED]    
3.
Martins LE, Werner B, Fonseca DG. Milia en plaque. An Bras Dermatol 2010;85:895-8.  Back to cited text no. 3
    
4.
Langley RG, Walsh NM, Ross JB. Multiple eruptive milia: Report of a case, review of the literature, and a classification. J Am Acad Dermatol 1997;37:353-6.  Back to cited text no. 4
    
5.
Cho E, Cho SH, Lee JD. Idiopathic multiple eruptive milia occurred in unusual sites. Ann Dermatol 2010;22:465-7.  Back to cited text no. 5
    
6.
Connelly T. Eruptive milia and rapid response to topical tretinoin. Arch Dermatol 2008;144:816-7.  Back to cited text no. 6
    
7.
Batra P, Tsou HC, Warycha M, Votava HJ, Stein J. Multiple eruptive milia. Dermatol Online J 2009;15:20.  Back to cited text no. 7
    
8.
Ishiura N, Komine M, Kadono T, Kikuchi K, Tamaki K. A case of milia en plaque successfully treated with oral etretinate. Br J Dermatol 2007;157:1287-9.  Back to cited text no. 8
    
9.
McCarley O'Shea E, Levy A, Frey J, Skinner R. Azithromycin therapy for multiple eruptive milia: A report of a case, new treatment option, and review of the literature. Internet J Dermatol 2009;7:1.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2]



 

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