Definition And Description

The affection known as Milium is characterized by the development, in the superficial layers of the skin, of a number of minute white papules looking something like small grains of sand. They are in reality sebaceous follicles, with occluded openings, distended by sebum. Their favorite seat is the neighborhood of the eyelids, although they are sometimes met elsewhere. They are usually quite numerous if the affection has existed for any length of time, but their course is indolent; they are painless and unaccompanied with inflammatory symptoms. They are most frequently met with in females, and rarely appear except in adults.

Diagnosis

The diagnosis is simple, as no other cutaneous affection resembles this one in appearance.

Prognosis

Milium rarely, if ever, produces any inconvenience except so far as it detracts from the comeliness of the visage. The tendency of the affection is toward increase in the number of the little granules, but they rarely attain a size larger than that of the head of a large pin.

Etiology

The causes which produce this occlusion of the sebaceous follicles are absolutely unknown.

Treatment

The principal indication is to remove the little granules as soon as they become large enough to permit of operative procedure. The instrument usually employed for this purpose is an ordinary lancet with which the stratum corneum that covers them is divided. The little grain is then dug out with the point of the instrument. To facilitate their extraction we have employed a needle-like instrument with a curved lanceolate point, as shown in Fig. 15.

Fig. 15. - Milium needle.

This little needle is quite similar to the one used by oculists in connection with the treatment of cataract. The needle is introduced in such a way that nearly the whole of the epidermis is removed from above the granule. Then, by a dexterous turn, the little tumor is pried out. After a little practice a large number can be removed in a very short space of time. To prevent their continual formation it is well to stimulate the functions of the skin, and to endeavor to keep the mouths of the follicles open by frequent frictions and the free use of soap and water about the affected parts. I am not acquainted with any internal medicines that possess the slightest influence over the affection.