Generic selectors
Exact matches only
Search in title
Search in content
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Net letter
2012:78:1;122-122
doi: 10.4103/0378-6323.90975
PMID: 22199087

A new site of milia en plaque

Ru-Zhi Zhang1 , Wen-Yuan Zhu2
1 Department of Dermatology, The First Affiliated Hospital of Bengbu Medical College, Anhui, China
2 Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

Correspondence Address:
Wen-Yuan Zhu
Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029
China
How to cite this article:
Zhang RZ, Zhu WY. A new site of milia en plaque. Indian J Dermatol Venereol Leprol 2012;78:122
Copyright: (C)2012 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Milia en plaque (MEP) is a rare benign epidermal tumor characterized by numerous tiny milia on an erythematous base that arise spontaneously on healthy skin in predisposed individuals without any apparent causative factor. MEP has preferential areas of involvement including the preauricular area, eyelids, periorbital area, inner canthus, supraclavicular, submandibular, earlobes, nasal bridge, and cheek. [1],[2],[3] To our knowledge, there are no reports of MEP appearing in a patient′s bilateral external auditory canals to date. Here, we describe an elderly female with this condition.

A 65-year-old woman developed skin-colored to gray papules on the internal surfaces of the end points of bilateral auricular canals over a 20-year period. During the first several years of the course, the patient infrequently consulted some dermatologists, but did not gain a definitive diagnosis since she refused to accept an incisional biopsy. Considering the lesions appearing as bilateral and asymptomatic and systemic examination revealing no other abnormality, a dermatologist comforted the patient by explaining to her that the lesions are nonmalignant, but a long-term follow-up was indicated. Therefore, the patient was reluctant to search for more medical opinions. Over the preceding 6 months prior to the initial presentation, the patient occasionally felt itchy. On examination the papules, 3 to 5 mm in diameter were grouped partly confluent and forming both massive lesions, symmetrically located at the end points of bilateral auricular canals [Figure - 1]a and b. A few sporadic papules could be seen around the masses. Close view revealed many slender and darkish hairs growing at the walls of the ear canal entrance. The patient did not have hearing loss and dizziness. Serological investigation for autoimmune diseases including lupus erythematosus was negative. We repeatedly persuaded her to perform a pathological examination, finally she agreed. A biopsy specimen from the lesion (an arrow indicates in [Figure - 1]a) was taken. Histological studies using hematoxylin and eosin (H and E) demonstrated a well-formed cyst just beneath the epidermis. The cyst was enveloped by the stratified squamous epithelium and surrounded by a moderate lymphocytic infiltrate [Figure - 2]a. Alcian blue/periodic acid-Schiff (AB/PAS) staining for mucin was carried out and was negative [Figure - 2]b. Based on the case history, clinical appearance of the lesions and pathologic findings, the diagnosis of MEP was made. The patient was prescribed topical 0.1% adapalene twice daily. Nine months later, the lesions had partially cleared and there was a significant decrease in milia count [Figure - 3]a and b and the patient was advised to continue the treatment.

Figure 1: Grouped skin-colored to gray papules, 3 to 5 mm in diameter on erythematous background, symmetrically locating at the end points of bilateral auricular canals (a: right; b: left)
Figure 2: Pathological examination. a: A well-formed cyst just beneath the epidermis was enveloped by the stratified squamous epithelium and surrounded by a moderate lymphocyte infiltrate (H and E, ×40) b: The AB/PAS staining for mucin was negative (×40)
Figure 3: Nine months later, the lesions partially cleared and there was a significant decrease in milia count (a: right ear; b: left ear)

Milia are rather common skin tumors and are classified as primary or secondary. Primary milia are derived from the vellus hair and the secondary milia present represent retension cysts derived from hair follicles and eccrine ducts. MEP is a quite rare variant of milia which occurs spontaneously without identifiable causative factors. The pathogenesis of MEP remains unclear. Some authors proposed damage to the adnexal structures, alteration of the infundibular portion of the follicle, or degeneration of elastic fibers may be attributable to milia formation.

In most of the previous reports, the lesions were distributed in the periauricular area and perioptic area. In 1996, Keohane et al., reported two cases of MEP which occurred on the inferior border of both ear lobes and on the ear lobes and anterior to the right tragus, respectively, and were treated with oral minocycline. [4] In contrast, the lesions in our report were symmetrically situated at the end points of auricular canals. Moreover, these lesions persisted for 20 years which is the longest course of the disease reported so far. We know many old people in China try to get wax out of their ears by poking things into the ear canal. However, our patient denied these actions which can do damage and cause infection. It is worth noting that much slender and darkish hairs growing at the walls of the ear canal were present. The observation may imply the relationship between the formation of milia and vellus hair.

The differential diagnoses include cutaneous myxomas, proliferative trichilemmal tumor and cyst, follicular mucinosis, but the clinical appearance and histopathological features are quite distinctive. In our case, AB/PAS staining for mucin was negative. The finding of H and E staining confirmed the diagnosis of MEP.

MEP is a benign process, but entails cosmetic problems. There is no standard treatment for MEP, but it can be treated by either surgical or medical modalities, including topical tretinoin, oral minocyclin, oral etretinate, ablative laser therapy or cryosurgery, dermabrasion, electrodesiccation, photodynamic therapy, radiosurgical destruction. [1-6] Among them, simple extraction or topical tretinoin is the mostly frequently tried option, with good response, especially in superficially located milia. Our patient obtained a satisfactory result after application of 0.1% adapalene cream for 9 months.

References
1.
Wollina U. Bilateral milia en plaque of the eyelids: Long eyelashes and unibrow: Case report and review of literature. Dermatol Surg 2010;36:406-8.
[Google Scholar]
2.
Hubler WR Jr, Rudolph AH, Kelleher RM. Milia en plaque. Cutis 1978;22:67-70.
[Google Scholar]
3.
Ishiura N, Komine M, Kadono T, Kikuchi K, Tamaki K. A case of milia en plaque successfully treated with oral etretinate. Br J Dermatol 2007;157:1287-9.
[Google Scholar]
4.
Keohane SG, Beveridge GW, Benton EC, Cox NH. Milia en plaque: New site and novel treatment. Clin Exp Dermatol 1996;21:58-60.
[Google Scholar]
5.
Van Lynden-van Nes AM, der Kinderen DJ. Milia en plaque successfully treated by dermabrasion. Dermatol Surg 2005;31:1359-62.
[Google Scholar]
6.
Al-Mutairi N, Joshi A. Bilateral extensive periorbital milia en plaque treated with electrodesiccation. J Cutan Med Surg 2006;10:193-6.
[Google Scholar]

Fulltext Views
311

PDF downloads
137
Show Sections