P24 Congenital milium of the nipple: a rare presentation

Congenital milium of the nipple is a rare condition, with limited cases reported. We present two cases highlighting an uncommon presentation of an otherwise common neonatal condition. Case 1: A 10-month-old female had a few-millimeter pearly papule on the left nipple, present since birth. After consultation with the Plastic Surgery team, a conservative approach was recommended, with the expectation of spontaneous resolution. Follow-up at 10 months showed no change in size or associated symptoms. Case 2: A 15-month-old male presented with a similar pearly papule on the right nipple, noted at birth. Follow-up at 10 months revealed a reduction in size, with no other concerns. Milia are benign, keratin-filled cysts that appear as yellow to pearly white papules and often resolve spontaneously in neonates. While most commonly seen on the face, congenital milia can occasionally affect other areas, including the nipple. A PubMed and Google Scholar search for 'milium' or 'epidermal inclusion cyst' of the nipple identified 11 cases, seven of which were congenital. These lesions were typically solitary, unilateral, and often described as pearly papules, ranging from a few millimeters to 2 cm. The two larger congenital lesions (1-2 cm) were reported as epidermal inclusion cysts. Five congenital cases were removed surgically, while two were managed conservatively, with spontaneous resolution documented in one after three months. Congenital milium of the nipple is a rare, benign lesion that should be considered in the differential diagnosis of nipple papules. Awareness of its potential for spontaneous resolution can prevent unnecessary intervention.