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Colloid milium, an expression of excessive sun exposure in Ecuadorian patients

References 1 Valent P, Akin C, Metcalfe DD. Mastocytosis: 2016 updated WHO classification and novel emerging treatment concepts. Blood 2017; 129: 1420–1427. 2 Hartmann K, Escribano L, Grattan C, et al. Cutaneous manifestations in patients with mastocytosis: consensus report of the European Competence Network on Mastocytosis; the American Academy of Allergy, Asthma & Immunology; and the European Academy of Allergology and Clinical Immunology. J Allergy Clin Immunol 2016; 137: 35–45. 3 Watkins CE, Bokor WB, Leicht S, et al. Telangiectasia macularis eruptiva perstans: more than skin deep. Dermatol Rep 2011; 3: e12. 4 Costa DL, Moura HH, Rodrigues R, et al. Telangiectasia macularis eruptiva perstans: a rare form of adult mastocytosis. J Clin Aesthet Dermatol 2011; 4: 52–54. 5 Severino M, Chandesris MO, Barete S, et al. Telangiectasia macularis eruptiva perstans (TMEP): a form of cutaneous mastocytosis with potential systemic involvement. J Am Acad Dermatol 2016; 74: 885–891. 6 Tumer G, Jow T, Lambert WC. Telangiectasia macularis eruptiva perstans: report of three cases. Am Soc Hematol 2011; 118: 5176. 7 de Cerqueira AMM, Feldman CA, Kanaan I, et al. Telangiectasia macularis eruptiva perstans. J Am Acad Dermatol 2011; 64: AB137. Colloid milium, an expression of excessive sun exposure in Ecuadorian patients Colloid milium (CM) is a rare deposition disease of uncertain etiology, although it has been widely related to sun exposure. We present three cases of Ecuadorian patients, a country located in the middle of the world, where its ultraviolet radiation (UV) index often reaches an extremely high level. The first patient is a 56-year-old woman with a17-year medical history of pruritic face lesions. On physical examination, small translucent papules located on the nose and right nasolabial groove were evidenced (Fig. 1a). Histopathology shows a dermal hyaline, amorphous, acellular material with clefts that stains Periodic Shiff Acid (PAS) positive (Fig. 1b). The second patient is a 42-year-old woman with a history of melasma treated with hydroquinone for one year, who presented a dermatosis of 3 years of evolution characterized by the presence of asymptomatic plaques conformed by multiple yellow-brown papules on bilateral malar regions (Fig. 1c). The biopsy study showed a thinned epidermis with a dermal deposit of a PAS-positive acellular homogenous material (Fig. 1d). The last patient is a 71-year-old man with a history of heart disease who presented a 3-year history of multiple waxy and shiny papules on the dorsum of the left hand (Fig. 1e). Histopathologic sections showed a dermal homogenous material with cleft-like spaces, disperse fibroblasts, and dilated capillaries (Fig. 1f). This condition was first described in 1866 by Wagner and has taken several denominations like colloid infiltration, milliary colloidoma, hyaloma, and elastosis colloidalis conglomerate. CM mostly affects middle-aged adults and fair-skinned individuals. It is considered a rare degenerative disease of unknown prevalence and origin, although it is believed that ultraviolet radiation is the most important triggering factor. UV exposure could cause degeneration of keratinocytes and elastic and collagen fibers with secondary accumulation of protein products and fibroblast secretions. Furthermore, it has been associated with hydroquinone use, ochronosis, trauma, chronic exposure to fertilizers, and petroleum products. CM is characterized by firm and waxy papules of each 5 mm that can be translucent, yellow-brown or skin color, and develop slowly and symmetrically. It predominates in sunexposed areas such as cheeks, ears, nose, neck, and (a) (b)