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December 1999

Multiple Papules on the Eyelids

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Arch Dermatol. 1999;135(12):1543-c-1548. doi:10-1001/pubs.Arch Dermatol.-ISSN-0003-987x-135-12-dof9025

Sections of the biopsy specimen showed a small cyst lined by thin, stratified epithelium containing concentric lamellae of keratin.

Milia are multiple, superficially located, pearly white papules, 1 to 2 mm in diameter. A distinction is made between primary and secondary milia.

Primary milia arise spontaneously, most commonly on the face, especially on the eyelids and cheeks. They are derived from the lowest portion of the infundibulum of the vellus hairs. Primary milia are small cysts that differ from epidermal cysts only in size. They are lined by stratified epithelium and contain concentric lamellae of keratin. On serial sections, each primary milium may be seen to be connected to a vellus hair follicle.1 Several cases of multiple eruptive milia have been described in which large numbers of tiny cysts are present on the face and upper part of the trunk.2 They develop in adult life, without any external cause. Primary milia are also common in the newborn. The occurrence of milia with trichoepithelioma and cylindroma in males in 3 consecutive generations of 1 family has been described.2

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