Differential Diagnosis for Bumps Resembling Milia in a 7-Year-Old

Single Most Likely Diagnosis

• Milia: These are small, white bumps that can appear on the skin, often on the face, and are very common in newborns. They occur when dead skin cells or keratin, a protein, get trapped under the skin surface. Given that the bumps have been present since birth and resemble milia, this is the most straightforward diagnosis.

Other Likely Diagnoses

• Ephelides (Freckles): While not typically described as bumps, freckles can sometimes appear as small, light spots and may be more noticeable in certain lighting conditions. They are very common in children and tend to darken with sun exposure.
• Sebaceous Hyperplasia: This condition involves the enlargement of sebaceous glands and can appear as small, yellowish or white bumps on the face. It's less common in children but could be considered given the description.
• Keratosis Pilaris: This is a harmless condition that causes small, rough patches on the skin, often on the arms, and can sometimes appear as small bumps. It's common in children and may be more noticeable in dry skin conditions.

Do Not Miss Diagnoses

• Tuberous Sclerosis: A genetic disorder that can cause skin lesions, including angiofibromas which might resemble milia. It's crucial to consider this diagnosis due to its potential systemic implications, including renal and cardiac issues.
• Multiple Syringomas: These are small, benign tumors that can appear as multiple small bumps, often around the eyes or on the face. While rare, they could be mistaken for milia and have implications for cosmetic and potentially systemic health.

Rare Diagnoses

• Basal Cell Nevus Syndrome (Gorlin Syndrome): A rare genetic disorder that can cause multiple basal cell carcinomas, which might initially appear as small bumps. It also has systemic implications, including an increased risk of other tumors.
• Trichoepithelioma: A rare skin condition that can cause small, skin-colored bumps, often on the face. It's part of a spectrum of conditions that can be benign but may have cosmetic implications.

Each of these diagnoses has a different set of implications for the child's health and treatment, ranging from benign conditions requiring no treatment to more serious conditions that may necessitate medical intervention. A thorough examination by a dermatologist or pediatrician is essential for an accurate diagnosis.