A congenital nipple pearl

Paediatric dermatology

Dr. Emmanuelle Bourrat

Saint-Louis Hospital

The clinical case
Now it's your turn!
Co-prescription and advice

Clinical case presentation

A healthy 3-month-old female infant with no previous history presented with a congenital lesion of the right nipple. The lesion was painless and non-progressive and therefore did not worry the parents or attract the attention of the attending physician. However, its persistence prompted a dermatological opinion: it was a small, firm, well‑limited white nodule located at the tip of the nipple, which it neither deformed nor invaginated.

There were no similar distant lesions, and the rest of the clinical examination was entirely normal.

Your turn

What is your diagnosis?

Select 1 answer(s) from the following choices:

Milium grain

Galactophoric ectasia

Montgomery tubercle

Breast enlargement with galactorrhea

Wrong answer!

Good answer!

Selected diagnosis

The most common congenital nipple anomalies are invagination, eversion and supernumerary nipples, and are well known to pediatricians.

This child's elementary lesion was suggestive of an epidermal cyst in an atypical topography: in fact, single or multiple grains of milium are frequent in the neonatal period but mainly on the cephalic extremity. A review of the literature revealed a few cases of congenital nipple milium, a pathology that is very rarely reported (probably due to its benign and anecdotal nature) but probably not exceptional.

These lesions, which share the same clinical and histological features as common milium, are most often congenital, rarely acquired, primitive (not post-traumatic) and usually evolve spontaneously.

Explanation of wrong answers

Galactophoric ectasia may cause a retention-type pseudotumor in the form of a subcutaneous swelling, sometimes accompanied by a serous or greenish discharge. It is not seen before puberty.
Montgomery’s tubercles correspond to the sebaceous glands of the mammary areola. They are more or less visible at any age and in both sexes, but become particularly visible during pregnancy and lactation.
Mammary outbursts during the Newborn’s genital crisis may be accompanied by a milky discharge or galactorrhea, which does not at all have the appearance of a solid “pearl”.

Treatment

Therapeutic abstention is the rule, given the generally spontaneously favorable prognosis of this benign dermatosis.

Message from the expert

Milium is a small epidermal cyst that is perfectly benign, trivial and transient at any age of life, but it is important to remember to recognize it in atypical topographies such as the nipple!

References

^{Muriel Guarda Ferreira and col Congenital milium of the nipple pediatric Dermatology 2047 (34) 1 e28-e29}