Derm Dx: White Papule Under the Eye - Clinical Advisor

Derm Dx: White Papule Under the Eye

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A 67-year-old man requests removal of a growth under his right eye. The lesion slowly has increased in size during the past year. The patient’s medical history includes hypertension, COPD, and anxiety disorder. His lipid levels are normal. Examination reveals a white papule that is removed with scissor excision.

Can you diagnose this condition?

A milium is a small, subepidermal cyst filled with keratin. Lesions range in size from 1 to 3 mm and are white in color. Milia may arise in proximity to an elevated base referred to as milia en plaque.1 These...

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A milium is a small, subepidermal cyst filled with keratin. Lesions range in size from 1 to 3 mm and are white in color. Milia may arise in proximity to an elevated base referred to as milia en plaque.1 These lesions are benign but often cosmetically bothersome. Milia can be removed with a simple extraction procedure.

Milia may result from trauma or occlusion; they also may be the sequelae of the subepithelial blistering disorder epidermolysis bullosa acquisita or the autoimmune disease bullous pemphigoid.2,3 Milia are one of the cutaneous hallmarks of porphyria cutanea tarda.4 They arise as blisters heal and are associated with regeneration of sweat glands and hair follicles.

Stephen Schleicher, MD, is director of the DermDox Center for Dermatology, as well as an associate professor of medicine at Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College

References

  1. Hubler WR Jr, Rudolph AH, Kelleher RM. Milia en plaque. Cutis. 1978;22(1):67–70.
  2. Stein JA, Mikkilineni R. Epidermolysis bullosa acquisita. Dermatol Online J. 2007;13(1):15.
  3. Amin S, Fiore CT, Paek SY. Milia within resolving bullous pemphigoid lesions. Proc (Bayl Univ Med Cent). 2019;32(1):90-92.  
  4. Nguyen LH, Khamisa K Porphyria cutanea tarda presenting as milia and blisters. CMAJ. 2018;190(20):E623.
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