Milia
Continuing Education Activity
继续教育活动
英文原文
Milia are benign and transient dermal cysts of keratine. These white appearing bumps are common, present in many different ways, and can develop in any areas of the skin, most commonly the face. The lesions are seen in about half of full-term newborns, and due to a lack of clinical relevance, they are paid little to no attention. The natural course of milia is self-limited, and in most of the cases will resolve without leaving a scar by one month of life. This activity reviews the evaluation and management of milia and highlights the role of the interprofessional team in evaluating and treating patients with this condition.
对应中文
粟丘疹是良性的、一过性的角质形成的表皮囊肿。粟丘疹这种白色肿块很常见，它有许多不同的表现形式，可发生在皮肤的任何部位，最常见的是面部。大约有一半的足月新生儿出现了这种病变，由于缺乏临床相关性，它们很少受到关注。粟丘疹的自然过程是自我限制的，在大多数情况下，出生后一个月病损就会消退而不留下疤痕。本活动回顾了粟丘疹的评估和管理，并强调了在评估和治疗这种疾病患者中跨专业团队的作用。
Introduction
引言
英文原文
Milia (singular: milium) are benign and transient dermal cysts of keratine that present as small firm white papules in various numbers most commonly distributed on the face, but they can also be present on other anatomical areas such as the upper trunk, extremities, and genital area (prepuce).
对应中文
粟丘疹(单发:粟粒疹)是一种良性的、一过性的角质形成的表皮囊肿，表现为小而硬的白色丘疹，多分布于面部，但也可出现在其他解剖部位，如躯干上部、四肢和生殖器区域(包皮)。
英文原文
The classification of milia includes primary and secondary. The vast majority of primary milia accounts for congenital milia that occur spontaneously and are present at birth, mainly over the nose, scalp, eyelids, cheeks, gum border (Bohn nodules), and palate (Epstein pearls). Still, there is another percentage of primary milia that may occur in association with certain rare genodermatoses (inherited genetic skin disorders) in children and adults. Meanwhile, secondary milia manifest in association with underlying skin pathology, medications, or skin trauma.
对应中文
粟丘疹的分类包括原发性和继发性。绝大多数原发性粟丘疹是自发出现的先天性粟丘疹，在出生时就存在，主要分布在鼻子、头皮、眼睑、脸颊、牙龈边缘和腭部。此外，在儿童和成人身上还有一部分原发性粟丘疹可能与某些罕见的遗传性皮肤病(遗传性皮肤病)一起发生。同时，继发性粟丘疹表现为与潜在的皮肤病理、药物治疗或皮肤创伤有关。
Etiology
病因学
英文原文
Mainly, primary milia are considered to arise from the lower infundibular sebaceous collar of the vellus hair follicles; meanwhile, secondary milia are believed to derive more frequently from the eccrine ducts than from hair follicles, sebaceous ducts or overlying epidermis.
对应中文
原发性粟丘疹主要来自绒毛毛囊的下漏斗状皮脂腺圈;与此同时，继发绒毛被认为更多地来自汗腺导管，而不是毛囊、皮脂腺或覆盖的表皮。
英文原文
The presence of primary milia also is linked with specific inherited genetic skin disorders (genodermatoses), which include oro-facial digital syndrome type 1, congenital hereditary trichodysplasia (Marie-Unna hypotrichosis), Basex-Dupre-Christol syndrome, and some other ectodermal dysplasias. An uncommon presentation of primary milia occurring on an erythematous plaque is known as milia en plaque, which etiology is still not well understood.
对应中文
原发性粟丘疹的存在也与特定的遗传性皮肤病(遗传性皮肤病)有关，包括口-面-指综合征、先天性遗传性毛发发育不良(玛丽·恩纳毛发不足)、Bazex综合征和其他一些外胚层发育异常。一种不常见的在红斑斑块上出现原发性粟丘疹的表现被称为粟丘疹斑块，其病因尚不清楚。
英文原文
Secondary milia may arise after trauma such as dermabrasion or radiotherapy. They also happen secondary to chronic topical steroid use with underlying atrophy, and nonsteroidal anti-inflammatory drug use. Besides, they may manifest after the clearing of inflammatory skin diseases as sequelae of bullous disorders.
对应中文
继发性粟丘疹可在外伤后出现，例如磨皮或放射治疗。它们也可继发于长期局部使用类固醇并伴有潜在萎缩，以及非类固醇抗炎药物使用后。此外，在炎症性皮肤病好转后，它们可能表现为大疱性疾病的后遗症。
Epidemiology
流行病学
英文原文
Primary congenital milia are so common that they could be considered as a typical variation, occurring in up to 40% to 50% of healthy full-term neonates. However, milia may be delayed in premature neonates. Primary and secondary milia occur without significant racial or sex differences; only milia en plaque lesions are more common in females. Moreover, milia can affect persons of any age but are most commonly seen in neonates with the congenital form.
对应中文
原发性先天性粟丘疹非常常见，可以被认为是一种典型的变异，在健康的足月新生儿中发生率高达40%至50%。然而，早产新生儿的粟丘疹可能会延迟出现。原发性和继发性粟丘疹的发生没有明显的种族或性别差异；只是粟丘疹样斑块病变在女性中更常见。此外，粟丘疹可以影响任何年龄的人，但最常见于新生儿的先天性粟丘疹。
Histopathology
组织病理学
英文原文
In 1956, Epstein and Kligman described that “milia are probably the commonest benign tumors of the skin.” Histopathologic studies support the notion that milia are not retention cysts, but instead, they represent a simple keratinizing type of benign tumor. Histologically, primary congenital milia look like small cysts of the vellus hair follicles emerging at the level of the sebaceous duct and contain walls of several layers of thick stratified squamous epithelium with a granular cell layer and in the center contain keratinous material. On the other hand, secondary milia lesions present with the same histological characteristics as primary milia lesions. They may also derive from any epithelial structure, including parts of the pilosebaceous apparatus and eccrine glands, such as epidermis, hair follicle, sebaceous duct, or sweat duct.
对应中文
1956年，Epstein和Kligman描述说：”粟丘疹可能是最常见的皮肤良性肿瘤”。组织病理学研究支持这样的观点：粟丘疹不是粘液囊肿，而是代表一种简单的角质型的良性肿瘤。在组织学上，原发性先天性粟丘疹看起来像皮脂腺管水平上出现的绒毛毛囊小囊肿，包含几层厚的分层鳞状上皮和颗粒细胞层，中心包含角质物质。另一方面，继发性粟丘疹病变具有与原发性粟丘疹病变相同的组织学特征。它们也可能来自任何上皮结构，包括毛囊皮脂腺和汗腺的部分，如表皮、毛囊、皮脂腺管或汗管。
History and Physical
病史与体格检查
英文原文
Generally, the most common type (primary congenital milia) manifests at birth, but its onset in premature newborns could manifest weeks later. Milia lesions commonly are asymptomatic and will resolve spontaneously during the first months of life. However, clinical information may change according to the milia subtype.
对应中文
一般来说，最常见的类型(原发性先天性粟丘疹)在出生时就表现出来，但在早产新生儿中可能在几周后出现。粟丘疹病变通常是无症状的，并将在生命的最初几个月自行消失。然而，临床症状可能会根据粟丘疹亚型而改变。
英文原文
When acquired (secondary milia), usually affect older children and a previous history of trauma or bullous skin disease could be present. This type of milia may persist without treatment.
对应中文
如果是获得性的(继发性粟丘疹)，通常影响大龄的儿童，既往可能有外伤或大疱性皮肤病病史。这种类型的粟丘疹不经过治疗可能持续存在。
Physical Examination
体格检查
英文原文
Typically, congenital milia lesions occur spontaneously, they consist of small white to yellow papules, less than 3 mm in diameter, and have a smooth dome shape. They could be associated with a faint blue hue in darkly pigmented skin. Milia vary from solitary to multiple grouped lesions. Usually found on the face, characteristically with the nose being involved most of the time.Benign acquired milia of children and adults also develop spontaneously. The distribution in children and adults of this type of milia favors the eyelids, cheeks, forehead, and genitalia area. Lesions of milia en plaque manifest as an erythematous plaque covered with multiple milia. They can reach several centimeters in size.Another type includes the acquired and widespread multiple eruptive milia, which appears abruptly over weeks to months. Multiple eruptive milia also in most of the cases occur sporadically. Nonetheless, it may be inherited in autosomal dominant fashion without other evident anomalies or be associated with certain genodermatosis.Milia related lesions to genodermatosis have been documented in association with Brooke-Spiegler syndrome, pachyonychia congenita type 2, basal cell nevus syndrome, among others. Disease-associated milia may occur with blistering skin diseases, such as porphyria cutanea tarda or epidermolysis bullosa.Milia also happen secondary to chronic topical steroid use with underlying atrophy and nonsteroidal anti-inflammatory drug use.Secondary traumatic milia most commonly arise after skin burns, skin grafting, dermabrasion, or radiotherapy.
对应中文
通常情况下，先天性粟丘疹病变是自发发生的，它们由白色至黄色的小丘疹组成，直径小于3mm，呈光滑的圆顶状。在深色皮肤中，它们可能呈现微弱的蓝色色调。粟丘疹是从单发到多发成群的病变不等。通常在面部发现，以鼻部受累为特征。儿童和成人的良性获得性粟丘疹也会自发形成。在儿童和成人中这种类型的粟丘疹分布倾向于眼睑、脸颊、前额和生殖器部位。斑块状粟丘疹病变表现为红斑上覆盖着多个粟粒疹。另一种类型包括获得性和广泛的多发性粟丘疹，它在数周至数月内突然出现。在大多数情况下多发性粟丘疹也是很少发生的。然而，它可能是常染色体显性遗传，没有其他明显的异常，或与某些遗传性皮肤病有关。与遗传性皮肤病有关的粟丘疹病变已被证实与Brooke-Spiegler综合征、2型先天性厚甲症、基底细胞痣综合征等有关。疾病相关的粟丘疹可能发生在大疱性皮肤病，如皮肤卟啉病或大疱性表皮松解症。粟丘疹也会继发于长期外用类固醇并伴有萎缩和使用非甾体抗炎药的情况下。
Evaluation
评估
英文原文
Milia lesions are diagnosed on clinical findings. Although seldom required, incision and drainage of the keratinous content of milia can corroborate the diagnosis. Additionally, persistent and widely distributed milia may require investigation for other causes of primary and secondary milia, such as an underlying genodermatosis, especially when other clinical findings are present.
对应中文
粟丘疹病变是根据临床结果诊断的。尽管没有必要，但切开和引流粟丘疹的角质成分可以证实诊断。此外，对于持续存在和广泛分布的粟丘疹，可能需要调查原发性和继发性粟丘疹的其他相关原因，特别是发现存在其他临床表现时，如潜在的基因皮肤病。
Treatment / Management
治疗/管理
英文原文
The lesions of congenital milia do not require any particular treatment since these lesions tend to resolve spontaneously. The other forms of primary milia, along with secondary milia may not resolve on its own, and they could be treated with simple surgical interventions such as evacuation, with a tiny incision with a scalpel blade and tangential pressure applied with a comedone extractor or curette. Other treatment options for multiple milia include topical retinoids and electrodesiccation or electrocautery.
对应中文
先天性粟丘疹的病变不需要任何特别的治疗，因为这些病变往往会自发消退。其他形式的原发性粟丘疹和继发性粟丘疹可能不会自行消退，它们可以通过简单的外科手术进行治疗，如用手术刀切开一个微小的切口，用粉刺提取器或刮刀进行切向压迫，进行清除。其他治疗多发性粟丘疹的方法包括局部外用维甲酸酯和电切或电灼。
Differential Diagnosis
鉴别诊断
英文原文
The principal differential diagnosis is sebaceous hyperplasia, which manifests as white to yellow grouped papules around the upper lip and nose. Similarly to congenital milia, sebaceous hyperplasia is less frequent in premature newborns. Other differential diagnoses could include comedonal acne, flat warts, milia-like idiopathic calcinosis cutie.
对应中文
主要的鉴别诊断是皮脂腺增生症，表现为上唇和鼻子周围的白色至黄色分组的丘疹。与先天性粟丘疹相似，皮脂腺增生在早产新生儿中较少发生。其他鉴别诊断可能包括粉刺性痤疮、扁平疣、粟粒状特发性皮肤钙质沉着症。
Prognosis
预后
英文原文
Congenital milia tend to resolve spontaneously without scarring within a couple of weeks, though they may persist for several months, usually disappearing during the first month of life. Acquired milia may continue without treatment.
对应中文
先天性粟丘疹往往在几周内自发痊愈，不留疤痕，尽管它们可能持续几个月，通常在出生后第一个月消失。后天性粟丘疹可能没有治疗而继续存在。
Complications
并发症
英文原文
No systemic complications have been documented. Milia are benign and asymptomatic lesions.
对应中文
目前还没有系统并发症的相关记录。粟丘疹是良性且无症状的病损。
Enhancing Healthcare Team Outcomes
增强医疗团队的成果
英文原文
Healthcare workers need to be aware that milia are benign and transient dermal cysts of keratin affecting different areas of the skin, most commonly the face (nose, gums, and palate). Despite that these lesions are often seen in about half of full-term newborns, they receive little attention.
对应中文
医护人员需要知道，粟丘疹是良性的、一过性的皮肤角质囊肿，可以影响皮肤的不同部位，最常见的是面部(鼻子、牙龈和腭部)。尽管大约一半的足月新生儿身上经常出现这些病变，但它们很少受到关注。
英文原文
The natural course of milia is self-limited, and in most of the cases will resolve without scaring at one month of life. However, if present in older children, they could be associated with an underlying inherited skin disorder or to be secondary to skin trauma. Thus in older age groups, these possible etiologies may need to be considered by physicians and nurses based on other historical and clinical findings to improve outcomes. But when in doubt about the diagnosis, the patient should be referred to dermatology. Finally, neonatologists, primary care providers, and nursing staff working in nurseries should provide education to caregivers and their families about this skin condition to improve patient-centered care.
对应中文
粟丘疹的自然过程是自限性的，在大多数情况下，在出生后一个月就会消退而不留下疤痕。然而，如果出现在年龄较大的儿童身上，它们可能与潜在的遗传性皮肤疾病有关，或继发于皮肤创伤。因此，在年龄较大的群体中，医生和护士可能需要根据其既往史和临床结果考虑这些病变可能的病因，以改善预后。但是当对诊断有疑问时，应将患者转到皮肤科。最后，新生儿科医生、初级保健医生和在托儿所工作的护理人员应向医护人员及其家属提供有关粟丘疹的相关教育，以改善患者的皮肤状况。
REFERENCES
1.Gallardo Avila PP, Mendez MD. Milia. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.