Mixed diagnoses – 10 cases (3 of 11)

She has multiple, dome-shaped, amber-coloured papules coalescing into a plaque over the lateral zygoma.

The disorder is known as colloid milium or colloid degeneration and is quite rare. A gooey gel can be expressed on puncture of a papule. Histology reveals eosinophilic amorphous material in the dermis, which appears ultrastructurally to be derived from degenerated elastic fibres.

Colloid milium is usually associated with excessive sun exposure and possibly with exposure to phenolic compounds. It affects the cheeks, eyelids, ears, neck, forearms and dorsa of hands. There is also an inherited juvenile variety.

It's not easy to eradicate colloid milium, but gentle electrosurgery, dermabrasion or laser resurfacing may result in an improvement in the appearance.

The patient should be advised regarding long-term sun protection using broad-brimmed hat and broad spectrum SPF30+ sunscreen.