|Year : 2012 | Volume
| Issue : 1 | Page : 44-45
Familial eruptive milia in two brothers: A rare presentation at a very young age
Ramesh Kumar, Saurabh Agrawal, Amrinder J Kanwar
Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
|Date of Web Publication||23-Oct-2012|
Amrinder J Kanwar
Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012
Source of Support: None, Conflict of Interest: None
We report a 7-year-old boy with spontaneous, rapid onset of multiple, tiny, white, superficial keratinous cysts over the neck, trunk, axilla and umblicus with few lesions over the face and similar lesions with same distribution in his 3-year-old younger brother. Their clinical presentations were compatible with the diagnosis of multiple eruptive milia (MEM). As far as we are aware, this is the first case of familial MEM to be reported in siblings of this youngest age group.
Keywords: Eruptive milia, keratinous cysts, Genodermatosis
|How to cite this article:|
Kumar R, Agrawal S, Kanwar AJ. Familial eruptive milia in two brothers: A rare presentation at a very young age. Indian J Paediatr Dermatol 2012;13:44-5
|How to cite this URL:|
Kumar R, Agrawal S, Kanwar AJ. Familial eruptive milia in two brothers: A rare presentation at a very young age. Indian J Paediatr Dermatol [serial online] 2012 [cited 2020 Jun 2];13:44-5. Available from: http://www.ijpd.in/text.asp?2012/13/1/44/102814
| Introduction|| |
Milia are the small, 2-3-mm-sized, benign, superficial, papules that may occur spontaneously (primary milia) or after healing of other dermatosis (secondary milia). Multiple eruptive milia (MEM) is a rare condition in which extensive lesions develops rapidly.  The first case of MEM was reported by Miescher in 1957.  Heard et al, reported the first case of familial MEM in 1971.
| Case Report|| |
A 7-year-old male child presented with asymptomatic, multiple, white, dome-shaped papules over the neck, shoulders and trunk and few lesions over the face, which began to develop by the age of 4 years [Figure 1]. Family history of similar lesions and distribution was present in his 3-year-old younger brother, in whom onset of lesions was noted by the age of 2 years [Figure 2]. There was no history of similar lesions in the parents and in first-degree relatives. On examination, both siblings had 1-2-mm-sized, yellowish-white papules over the neck, shoulders, axillae, abdomen and umbilicus. Skin biopsy was not performed as the parents did not agree to the same. Topical tretinoin 0.05% was prescribed.
|Figure 1: Multiple, white, 1– 2-mm-sized tiny papules on the neck and abdomen (in the 7-year-old elder brother)|
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|Figure 2: Multiple, white, 1– 2-mm-sized tiny papules on the neck and abdomen (in the 3-year-old younger brother)|
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| Discussion|| |
Milia can be classified as primary milia, which are believed to originate from the undifferentiated sebaceous collar of vellus hairs, while secondary milia mostly arise from the eccrine sweat ducts and, less commonly, from the hair follicle and aberrant epidermis.  Primary milia develop spontaneously and predominantly present over the face and trunk, whereas secondary milia may present at any site of the body after the healing of trauma (burn, dermabrasion) or subepidermal bullous disorders. MEM were classified into three types by Langley et al.:  (1) spontaneous (idiopathic), (2) familial (autosomal dominant) and (3) associated with genodermatosis.
Usually, MEM localized to sun-exposed sites suggest the role of sunlight as a causative factor.  Because in our patients milia developed predominantly over the sun-protected areas, other factors such as unknown genetic or environmental factors like friction may play a role in the pathogenesis of MEM. Diba et al, reported the youngest case of spontaneous MEM in a 9-year-old male child with involvement of the nose, cheeks and shoulders. Familial autosomal-dominant MEM cases have also been described. Reported cases include a father and son with MEM on the face, neck, shoulders, neck and axillae  and a mother and son with involvement of the face and upper trunk with associated striate leukonychia.  In our case, we hypothesize either an X-linked recessive or autosomal-dominant mode of inheritance. Because MEM were present only in male offsprings without any maternal or paternal history, an X-linked recessive mode of inheritance is more likely because of a sporadic mutation in the maternal side that had been transmitted to the male offsprings and that expressed itself phenotypically.
Genodermatosis associated with MEM are Bazex syndrome, orofacialdigital syndrome type 1, Rombo and Gardner's syndrome.  Miliaria crystellina, eruptive syringoma, verruca plana, eruptive vellus hair cyst and generalized idiopathic calcinosis cutis require differentiation from MEM. Commonly used treatment modalities are extrusion, electrocautery, electrodessication, carbon dioxide laser  and topical tretinoin and ER:YAG laser. 
In summary, to the best of our knowledge, we report the youngest case of familial MEM with involvement of the uncommon sites.
| References|| |
|1.||Berk DR, Bayliss SJ. Milia: A review and classification. J Am Acad Dermatol 2008;59:1050-63. |
|2.||Miescher G. Eruptive milia and Brooke's epithelioma adenoides cysticum. Dermatologica 1957;115:712-6. |
|3.||Heard MG, Horton WH, Hambrick GW Jr. The familial occurrence of multiple eruptive milia. Birth Defects Orig Artic Ser 1971;7:333-7. |
|4.||Tsuji T, Sugal T, Suzuki S. The mode of growth of eccrine milia. J Invest Dermatol 1975;4:388-93. |
|5.||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. |
|6.||Diba VC, Handfield-Jones S, Rytina E, Hall P, Burrows N. Multiple eruptive milia in a 9-year-old boy. Pediatr Dermatol 2008;25:474-6. |
|7.||Schimpf A, Pons F. Multiple eruptive milia and striated leuconychia. Z Hautkr 1974;49:207-14. |
[Figure 1], [Figure 2]