Causes Of Milia
THE POSSIBLE UNDERLYING ISSUES
Milia can be present on anyone’s skin. Milia are benign, small, white, keratinous cysts. They are superficial in nature, that commonly appear on the cheeks, eyelids, and, genitalia of children and adults. Milia, unfortunately, has no distinction on age or colour. It can be present when we arrive in this world as a baby or randomly appear after having a tattoo. Most of the time though, there is an under lying medical reason for why they have appeared.
Is there more than One form of Milia & what causes them?
There are two main forms of Milia, primary Milia and secondary Milia. Both show as ‘pearls’ on the skin most of the time and look the same. Milia primary is recognized by its’ attachment to the sebaceous collar.
- Milia Secondary is recognized by its’ eccrine attachment.
- Primary Milia connects to the lower sebaceous collar of the Vellus hair and turns into a keratin-filled cyst.
Primary Milia usually spontaneously appears.
Secondary Milia emerges from the Eccrine ducts. Secondary Milia are also tiny keratin cysts and look similar, but these develop after something clogs the ducts leading under the skins surface and secondary Milia can also appear on the skin because of a more traumatic condition or event.
Can Milia be misdiagnosed?
Milia are can be wrongly diagnosed as;
- Comedonal acne
- Flat warts
- Molluscum contagiosum
- Sebaceous hyperplasia
- Milia-like idiopathic calcinosis cutis
- Acne Vulgaris
- And other forms of skin disorders.
Luckily, the very distinct ‘Pearl’ look of Milia in most cases will eventually result in the correct diagnoses of Milia being the skin condition affecting you.
What are the various Milia Definitions?
Primary Milia is broken down into various classifications.
- Primary Milia
- Congenital Milia
- Multiple eruptive Milia
- Benign primary Milia of adults and children
- Milia en plaque
- Nodular grouped Milia
- Genodermatoses-associated Milia
- Nevus de-pigmentosus with Milia
We will now cover the criteria for the Milia definition per classification;
Congenital Milia, what causes it?
Congenital Milia appears commonly on new-born babies. Up to 85% of healthy new-borns having them when born or have them appear soon after birth. Premature babies do not usually succumb to them.The good news is, that this will just resolve itself and it is nothing to worry about. So, if you are reading this to get information on what could be wrong with your child, relax and stop worrying.
It is a very common thing and it will clear up by itself. The school of thought is that the skin is just finishing up on the last of its jobs and that it is just leaving the last elements of the Velluar hair
until last. This is one of the only Milia, which will disappear over time.
The Cause Of Multiple Eruptive Milia.
Multiple eruptive Milia will normally just appear and is a collection of lots of Milia. They can appear over the course of a couple of week to a couple of months. They are a lot more sporadic in placement, forming into an enlarged cluster.
These multiple eruptions can occur from an autoimmune irregularity or be associated to a genodermatosis.
Genodermatosis are classed as inherited genetic skin conditions, often grouped into three categories: chromosomal, single gene, and polygenetic.
Multiple eruptive Milia have also been reported in association with Genodermatoses, such as the basaloid follicular harmatoma syndrome, orofacodigital syndrome I, Rombo syndrome, Bazex syndrome, and Gardners syndrome.
Multiple eruptive Milia can also manifest for no reason, although this is rare.
Understanding what causes Benign primary Milia.
Benign primary Milia of adults and children also, like multiple eruptive Milia, commonly appear for no reason. It will most likely appear on, either, the eyelids, forehead cheeks or genitalia.
There is no reasoning upon it appearance, so a lot of the medical industry feels that this can be the result of an autoimmune flare up. Stress can greatly increase the chances of an autoimmune flare-up.
The appearance of benign primary Milia has also been associated with too much sun exposure. We all know how bad the sun is for our skin, but we still expose ourselves to the elements and the skin can invoke Milia as part of its healing or protection stages.
The Cause Of Milia En Plaque (MEP) Explained.
Milia en plaque (MEP) is a rare form of primary Milia. Its characterization is the presence of Milia on an infiltrated erythematous plaque. These can be large, sometimes up to 5 cms. They are, on examination, a group of 1- 3mm Milia that has amalgamated into a much larger collective. Their commonly found on the face area, and behind the ears. In small cases it can surface anywhere on the body. They need to be clinically diagnoses to make sure they are not come-done nevus or Favre-Racouchot disease.
Sometimes the Milia en plaque has no Pearl and is fixated upon the sub cellular levels of the skin. Milia en Plaque will commonly cluster into an oval shape.
They can appear for no medical reason on healthy individuals, but their proven to have an association with Lichen Planus, discoid lupus erythematosus and pseudoxanthoma elasticum. Even when treated, there is a very small chance that the Milia en Plaque can return, due to the irregularity of the Milia structure.
With the presence of lesions at different depths in the skin and the inflammatory infiltrate of varying degrees of intensity, any ‘Milia en plaque treatment plan’, should always be individualized.
Nodular Grouped Milia, What Causes It?
Nodular grouped Milia come under the classification of dermal keratin-filled cysts, surrounded by a moderate lymphocytic inflammatory infiltrate.
They are a collection of Milia surrounded with a small amount of liquid which over comes most of the ‘pearl appearance’.The liquid that covers the underlying Milia will join to make a random nodular shape. It is more irregular and patchy in shape than Milia en plaque, which usually presents in an oval.
Like most Milia, which can appear for no reason, this Milia is the same. It is a normal patch of Milia where liquid has engorged the keratin and distorted it proportions.
Genodermatoses – Associated Milia Causes.
Genodermatoses – associated Milia could be the minor or major feature of many an underlying problem. This form of Milia have been found to be in association with basal cell nevus syndrome, atrichia with papular lesions, Rombo Syndrome, Rookespielger syndrome and pachyonychia congenita type 2.
Milia show up with most cases of Bazex-Dupre-Christol syndrome. Genodermatoses classifies as an inherited genetic skin condition, often grouped into three categories: chromosomal, single gene, and polygenetic.
All these characterisations can manifest primary or secondary Milia as a side effect. The Milia may appear beside another skin disorder. This genetic autoimmune disorder is rare, although a bad skin structure from birth or a history of family members with primary and secondary Milia can be a good indicator.
The Underlying Cause of Nevus De-Pigmentosus With Milia
Nevus de-pigmentosus with Milia occurs when the skin has areas of non-pigmentation. Non-pigmentation is a skin disorder on its own, but sometimes the area with no pigment can have a group of Milia.
Nevus de-pigmentosus Milia is restricted to the area of the skin with no pigment. This is the area where there is a distinct lack of melamine.
Nevus de-pigmentosus Milia will present themselves as small epidermal cysts in the papillary dermis and basal layer hypopigmentation, with decreased melanin, but a normal number of melanocytes. It occurs due to de-pigmentation trauma of the area, so could be either primary or secondary Milia on diagnosis.
Milia classification and Histology Under the microscope, the position of the keratin will determine primary Milia or secondary Milia. There is a classification as Primary Milia if there is an attachment to the collar of the Vellus hair or secondary with eccrine attachments. Secondary Milia is broken down into;
- Disease-associated Milia
- Medication-associated Milia
- Trauma-associated Milia
Disease-associated secondary Milia
Disease-associated secondary Milia can be an inherited genetic skin condition. It may also arise from an autoimmune disorder, the same as Genodermatoses – associated Milia. Diabetics and Lupus sufferers commonly have bouts of secondary Milia appear. Disease-associated secondary Milia can arise from kidney issues to neurosis, hereditary rickets and abnormal dermatoglyphics.
There are multitudes of skin conditions and autoimmune conditions that can present secondary Milia. As a primary or secondary indicator to the main disease, that the investigation of any underlying issues should be checked if possible with a doctor, if you get a secondary outbreak after treatment. It can also be a side effect of alopecia and hair loss. Called Atrichia with papular lesions, which is an autosomal recessive disorder, caused by mutations in Hair loss / hair less.
The skin cell disruption from the loss of hair makes the Milia appear in the place of some areas of hair loss. Thought the first assumption would be that it was due to the hair follicle, so it is classed as primary Milia, the cells instead distort the eccrine ducts with attachments inside the Milia. The Milia can also appear from a general short-term disorder of the basal cells.
Medication-associated Milia can form when you take a medication, which has the ability to enter the skin as an organ, whether internally or externally. Although they can be a rare side effect of some of today’s pharmaceuticals, some medication has a higher number of cases where secondary Milia appeared as a side effect.
These include fluorouracil, cyclosporine, penicillamine, benoxaprofen and topical steroids. That is not to say that you will get Medication-associated Milia, if you take these medicines.
Treatment for mycosis fungicides commonly result in Milia. No one understands yet if the Milia are a side effect of the medication for the treatment or the actual disease itself. Any medication, which will affect you on a cellular level, to varying degrees, will inherently increase the possibility of a skin disorder such as Milia appearing.
Trauma-associated Milia arises when the skin suffers a trauma in some form. The trauma creates Milia through epidermal implantation or by providing a stimulus for undifferentiated Pilosebaceous cells to proliferate. Radio therapy, Deep Invasive chemical peels, Tattoos, skin grafts, burns or ablative laser therapy, are just some of the reasons for Milia in that area.
Any time the skin has suffered on a cellular level, there is the possibly of Milia resulting in the area.
Until recently, Dermabrasion was a treatment for Milia. After studies, it was found that this treatment causes Milia regrowth due to the trauma on the skin. You could use dermabrasion to treat a few Milia, only to find that you have now increased the Milia in number.
The trauma of dermabrasion treatment will chop up cells and can disrupt your skins normal healing process, leaving your skin with multiple avenues for the Milia to present itself.
The actual treatment is causing the milia to spread. The same applies to treatment by lasers. If you smash a cell to aid its removal then the surrounding cell walls will be impregnated with instructions to replicate with that new genetic recipe. This can be true as well for extraction of the Milia, which some people recommend. You are causing more trauma to a skin disorder, which proliferates on skin trauma.
Try a dedicated treatment Protocol for Milia, such as Cerobio Milia treatment. It is specially formulated to be fast and effective, as well as gentle on your skin.