Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2022;12(2):e2022086 1

Milium of the Nipple
Li-wen Zhang1, Juan Wu2, Ling-yi Zhao1, Tao Chen1

1 Department of Dermatovenereology, Chengdu Second People’s Hospital, Chengdu, Sichuan, China

2 Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China

Citation: Zhang L, Wu J, Zhao L, Chen T. Milium of the Nipple. Dermatol Pract Concept. 2022;12(2):e2022086. DOI: https://doi 
.org/10.5826/dpc.1202a86

Accepted: October 7, 2021; Published: April 2022

Copyright: ©2022 Zhang et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, 
distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing interests: None.

Authorship: All authors have contributed significantly to this publication.

Corresponding author: Tao Chen, Department of Dermatovenereology, Chengdu Second People’s Hospital, 165 Caoshi Street,  
Chengdu 610017, Sichuan, China. E-mail: 13980427003@163.com

Case Presentation

A 4-year-old boy presented with a 1-year history of a  single 

pearly white papule on the right nipple (Figure 1A). No 

previous skin inflammation or trauma was observed at the 

same location. The left nipple was normal. His growth and 

psychomotor development were normal. The dermoscopy 

showed a pearly white rounded structure with branching 

vessels (Figure 1B). Histopathology showed an epidermoid 

cyst containing keratinous material (Figure 1C). The diagno-

sis of milium was made.

Teaching Point

Milium is a common benign keratinous cyst characterized 

by pearly white dome-shaped lesion of 1 mm to 4 mm in 

diameter, but the involvement of the nipple seems to be rare 

and bigger. Milium may occur as either primary or second-

ary lesions. Four cases of milium involving the nipple were 

found by searching PubMed databases [1,2]. Among them, 

the male-to-female ratio was 1:3; the age range was from 6 

to 16 months. They presented a unilateral single pearly white 

dome-shaped papule with a diameter of 3 mm to 8 mm. Three 

cases underwent surgical excision, and 1 spontaneously dis-

appeared. The dermoscopic manifestation shows a white or 

yellowish-white rounded structure with linear or branching 

vessels. The differential diagnosis includes molluscum con-

tagiosum, calcinosis cutis, juvenile xanthogranuloma, and 

syringoma. 

References

1. Ferreira MG, Salgado MB. Congenital Milium of the Nipple. Pe-

diatr Dermatol. 2017;34(1):E28–E29. DOI: 10.1111/pde.13010. 

PMID: 27778385.

2. Jain S, Sarkar R, Garg VK, Khurana N. Epidermal inclusion 

cyst or giant milium of the nipple. Indian J Dermatol Venereol 

Leprol. 2012;78(1):103–105. 2011/12/27. DOI: 10.4103/0378-

6323.90960. PMID: 22199072. 



2 Image Letter | Dermatol Pract Concept. 2022;12(2):e2022086

Figure 1. (A) A single pearly white papule on the right nipple. (B) The dermoscopy showed a pearly white rounded structure with branching 

vessels. (C) Histopathology showed an epidermoid cyst containing keratinous material (H&E; ×100 magnification)