Milium grains in newborns

The milium grains in babies are characterised by white or yellowish skin rashes measuring a few millimetres in diameter, appearing on the face and also on the genital organs. They resemble small skin cysts, filled with keratin arranged in layers. There are mainly two forms of milium grains in babies:

• Congenital Milia. It is possible to observe a very limited number of milia at birth. These lesions naturally dissipate in just a few months. The epidermal cysts known as "Epstein's pearls" are found on the palatal mucosa (of the palate) at birth.

• "Simple" milia grains. They appear spontaneously due to the obstruction of hair follicles. When dead skin cells do not exfoliate, they prevent the growth of hair follicles. Above them, new skin forms and retains them under the skin. These cells, and specifically the keratin, solidify and transform into cysts. In children, the distribution of this type of milia is more prevalent on the eyelids, cheeks, forehead and genital region. In most cases, they disappear without leaving any traces by the end of the first month of life.

• Milium grains associated with genodermatoses. Indeed, milium grains can appear following genodermatoses, in very rare cases. These are genetic dermatological diseases. However, these lesions disappear completely and spontaneously. This is the case for benign transient bullous epidermolysis, congenital absence of dermatoglyphs or even the type 1 orofaciodigital syndrome.

Note : It is common to confuse milia withsebaceous hyperplasia in newborns. Present in 30 to 50% of infants, these are small white or yellowish lesions on the cheeks, nose and upper lip. During the last month of pregnancy, hormonal stimulation leads to an increase in the number and size of the sebaceous glands, which causes this hyperplasia. These lesions also naturally disappear within a few weeks. However, they exhibit a greater depth and a more yellow hue than milia.

Milium grains require no specific management. As previously mentioned, they disappear during the first few months of life in babies. Moreover, it is advised against using treatments aesthetic used in adults, as they pose abrasive risks to the sensitive skin of babies.

the skin barrier is typically formed during the third trimester of pregnancy. Consequently, the skin of an infant exhibits structural and functional immaturity. It is considered thin and fragile with increased sensitive water loss, vulnerability to trauma and bacteria, due to an epidermal permeability that facilitates the penetration of foreign substances and the immaturity of metabolising systems. Treatments prescribed for adults, such as extraction, the CO 2 laser and the application of topical retinoids are not suitable for infants. They could cause wounds, irreversible scarring and disrupt the baby's internal balance.

Do not attempt to remove your baby's milia yourself. If in any doubt, we advise you to consult your dermatologist.

• DARMSTADT G. L. & al. Neonatal skin care. Pediatric Clinics of North America (2000).

• BARBAROT S. & al. Les grains de milium de l’enfant. Annales de dermatologie et de vénéréologie (2009).

• GALLARDO AVILA P. & al. Milia. StatPearls (2023).