Milia En Plaque Associated With Prayer-Related Frictional Changes

Milia en plaque (MEP) is an uncommon dermatologic condition characterized by grouped milia on an erythematous plaque. Its underlying cause remains unclear, though various internal and external factors may contribute. We present the first reported case of MEP linked to prayer-related frictional changes. A 67-year-old South Asian male developed a well-demarcated plaque with agminated milia on his forehead at the site of chronic mechanical friction from prayer-related prostration. Histopathology revealed cystically dilated follicles and inclusion cysts without atypia. Surgical excision led to complete resolution without recurrence at two months, with an excellent cosmetic outcome. This case highlights not only a novel trigger for MEP but also suggests that surgical excision may be an effective treatment option for localized lesions, offering favorable aesthetic results. Awareness of mechanical factors in MEP pathogenesis may guide prevention and individualized management strategies.