MILIUM

Synonyms.—Grutum; Strophulus; Strophulus albidus; Tuberculum sebaceum;
Pearly tubercles; Acne albida; Fr., Acné miliare.

Definition.—A small whitish or yellowish, rounded, pearly, non­
inflammatory formation, situated in the upper part of the corium.

Symptoms.—The favorite sites are about the face, especially
about the eyelids, although they may occur, although much less fre­
quently, on other parts, more particularly on the penis and scrotum
and on the labia majora and labia minora. The lesions are usually
pin-head in size, whitish or yellowish, often with a somewhat pearly
luster, and sometimes seemingly more or less translucent. They are
rounded or acuminated, project slightly above the surface, and are
without aperture or duct. They develop slowly, their appearance
being insidious, and after reaching a certain—variable—size, usually
remain stationary for years. In number they may be scanty, scarcely

MILIUM

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more than several being present, or they may exist in greater or less
profusion. While almost invariably irregularly disposed, exceptionally
a tendency to grouping has been noted (Crocker). Their presence gives
rise to no disturbance; there are no subjective symptoms, and unless of
large size or existing in numbers cause but slight disfigurement. Occa­
sionally they attain greater size, or two or three may become bunched
or coalesce, and reach the dimensions of a small pea or larger. In rare
instances, and more especially in milia of some size, one or several may
undergo calcareous metamorphosis from the deposit of carbonate and
phosphate of lime, and become quite hard and stony, constituting the
so-called cutaneous calculi.

Etiology and Pathology.—Milia are seen at any age. They
are not infrequent in infants (so-called strophulus albidus). They are
of common occurrence in adolescence and early adult life, especially
in women, and in some instances are associated with comedo and acne.
They have been noted to occur at the sites of pemphigoid lesions (Bären-
sprung, Hebra, Hallopeau, Neisser, Behrend, Bowen, and others), after
erysipelas, and along the edges of scars. In most cases, however, no
cause can be assigned.

The formation is situated just beneath the epidermis, which con­
stitutes its external covering. In the opinion of most writers the affec­
tion results from retention of sebaceous matter in one or more acini of the
sebaceous glands, although others, among whom Virchow, Rindfleisch,
and Unna, hold its seat to be in the hair-follicles. According to Neu­
mann and others, the covering proper is either the wall of the hair-
follicles or sebaceous glands. Robinson believes that two different con­
ditions have been described under this name, and that “where the for­
mation is superficially seated, contains no fatty epithelium, shows no
connection with a sebaceous gland, and no duct in connection with
it, it is a case of miscarried embryonic epithelium from a hair-follicle
or from the rete; the lesion consisting of somewhat lobulated collec­
tions of corneous-like cells, the whole collection being surrounded by a
more or less perfectly formed capsule, from pressure exercised by the
growing new formation, and provided with septa of fibrous connective
tissue.’’ Philippson also holds this view.

In most milia the contained mass is made up of closely packed seba­
ceous matter, with a disposition in some instances to become inspissated
and calcareous.

Diagnosis.—Milium is to be distinguished from comedo by the
absence of the duct orifice and blackish point of the latter. Somewhat
large and flattened milia may present a faint suggestion of xanthoma,
but this latter disease (q. v.) is of so entirely different nature that a mis­
take can scarcely occur. The central depression and aperture and larger
size of molluscum contagiosum lesions will prevent its confusion with the
latter.

Prognosis and Treatment.—Milia are persistent, with little,
if any, tendency to spontaneous involution, except in infants, in whom,
after a variable time, they usually disappear. They are benign, have
no prejudicial influence, and are rapidly amenable to treatment.

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DISEASES OF THE APPENDAGES

Occurring in infants and young children, the free use of soap and
water, and the occasional application, by rubbing in, of mild sulphur
ointment, from 20 to 40 grains (1.33-2.65) to the ounce (32.), will often
suffice to bring about the disappearance of the lesions. In others,
and more especially in adults, mild operative interference is necessary.
This consists in puncturing the little growths, squeezing out their con­
tents, and in the larger lesions touching the interior with silver nitrate
or a weak carbolic acid lotion, from 20 to 30 grains (1.33-2.) to the ounce
(32.). Electrolysis is an available and satisfactory method. In the
rare cases in which the contents become calcareous superficial curetting
or a small incision and shelling out the contained mass will be required,
followed by slight cauterization as already indicated. In older children
and adults, when the lesions are quite numerous and somewhat closely
crowded, the use of a peeling paste (see Acne) will commonly cause them
to be exfoliated. The careful application of soft soap sufficiently long
to produce a mild dermatitis is also likely to have the same result.

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