A full-term female neonate born by emergency lower segment Caesarean section (for the indication of breech in labor) was referred to us for evaluation of a profuse eruption of white lesions on her face. On examination, a profuse eruption of shiny, pearly white papules was noted on chin, forehead, cheeks and nose (Fig. 1). Mild hypertrichosis was also present on face. Rest of the mucocutaneous examination was normal. No specific treatment was prescribed. At a follow-up visit, all the lesions had completely resolved. Based on the classic presentation and natural resolution of the lesions, a clinical diagnosis of neonatal milia was made.

Fig. 1 Shiny, pearly white papules on chin, forehead, cheeks and nose.

Milia are one of the most common transient skin disorders in neonates being present in up to 30-50% of neonates. These consist of 1-2 mm white or yellowish papules on the face; the nose is usually predominantly affected. Less commonly, trunk and extremities are also involved. Milia are epidermal keratin cysts developing in connection with the pilosebaceous follicle. Similar inclusion cysts may also be seen on the palate (known as Epstein pearls); when they occur on the alveolar margins, they are termed Bohn nodules. Main differential diagnoses of milia include sebaceous hyperplasia (more yellow), molluscum contagiosum (dome-shaped papules with central umbilication), miliaria crystallina (skin-colored pin-pint clear vesicles), bacterial and candidal lesions, and transient neonatal pustular melanosis (superficial vesiclopustules that are present at birth, rupture within 24-48 hours and heal with hyperpigmented macules). No treatment is required for neonatal milia as these spontaneously resolve in a few weeks.