Clear Skin and Hair Laser Center

MILIA

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Overview of Milia or Types and treatment of Milia 

Milia are multiple tiny pearly white bumps, usually seen on cheeks, nose, eyes, forehead, neck, and chest areas. A milium (single milia) is a small cyst containing protein keratin. They are formed when keratin produced by the skin gets entrapped beneath the outer layer of the skin, forming a tiny cyst. An individual milium is formed at the base of a hair follicle or sweat gland. 

What are the causes & types of Milia formation?

Milia are found in all ages and both sexes. They most often arise on the face, predominantly on the eyelids and cheek, and occur elsewhere.

The cause depends on the variants of milia:

Neonatal milia: seen nearly in half of the newborn babies; and common over around eyes, cheeks, inside the mouth. They heal spontaneously within a few weeks of birth.

Primary milia: are formed directly from entrapped keratin and are usually found on the faces of infants and adults. They occur both in children and adults. These types of milia found in infants tend to heal on their own within several weeks and found in adults tend to be long-lasting.

Secondary milia or Traumatic Milia: occur at the site of injury or burn or blistering, as the skin heals. They are formed due to the clogging of eccrine sweat ducts.

Milia en plaque

Multiple milia are formed on the inflamed or reddened and elevated area on the eyelid, behind the ear, or jaw.plaque up to several centimeters in diameter; sometimes associated with other skin diseases such as discoid lupus erythematosus, lichen planus.

Multiple eruptive milia: appear as crops of numerous milia. Most often affect the face, upper arm, or upper trunk.

Juvenile milia: appear at birth or later in life; and associated with genetic disorders and epidermolysis bullosa.

Milia associated with drugs: rare seen to the use of topical medication, such as corticosteroid, hydroquinone, and 5FU.

Signs and Symptoms

Milia are neither itchy nor painful and appear as 1–2 mm pearly white, dome-shaped bumps.

The most common locations for primary milia:

· Around the eyes, cheeks, nose, and forehead in adults and infants

· Inside the mouth (gums & palate) of infants; and are called Epstein’s pearls.

The most common locations for secondary milia:

· Anywhere on the body where another skin condition exists, particularly on the backs of the hands

· On the faces of people who have had a lot of damage from sun exposure

What is the treatment of milia?

Milia do not need to be treated unless cosmetically undesired for the patient. They are usually harmless and with time resolve on their own. 

Medical treatment:

Topical retinoid cream such as tretinoin or adapalene may be helpful for widespread lesions.

Minocycline has been shown to improve milia en plaque.

Chemical peels or microdermabrasion or dermabrasion: series of sessions are required to be effective for very extensive milia.

Cryotherapy can be applied to destroy the lesions 

Surgical removal by de-roofing using a sterile needle or blade and the contents squeezed out.

The radiofrequency device can destroy the top layer of skin and later curettage the material.

Laser ablation by co2 or erbium YAG is a recent and effective method to remove extensive milia.

However, milia are found in the outer layers of skin and are difficult to remove. Do not make an attempt to remove them at home as it may leave a mark or scar. The best method of removal of milia is by Ellman radiofrequency device or laser.

Milia 

Milia are multiple tiny pearly white bumps, usually seen on cheeks, nose, eyes, forehead, neck, and chest areas. A milium (single milia) is a small cyst containing protein keratin. They are formed when keratin produced by the skin gets entrapped beneath the outer layer of the skin, forming a tiny cyst. An individual milium is formed at the base of a hair follicle or sweat gland. 

What are the causes & types of Milia formation?

Milia are found in all ages and both sexes. They most often arise on the face, predominantly on the eyelids and cheek, and occur elsewhere.

The cause depends on the variants of milia:

Neonatal milia: seen nearly in half of the newborn babies; and common over around eyes, cheeks, inside the mouth. They heal spontaneously within a few weeks of birth.

Primary milia: are formed directly from entrapped keratin and are usually found on the faces of infants and adults. They occur both in children and adults. These types of milia found in infants tend to heal on their own within several weeks and found in adults tend to be long-lasting.

Secondary milia or Traumatic Milia: occur at the site of injury or burn or blistering, as the skin heals. They are formed due to the clogging of eccrine sweat ducts.

Milia en plaque

Multiple milia are formed on the inflamed or reddened and elevated area on the eyelid, behind the ear, or jaw.plaque up to several centimeters in diameter; sometimes associated with other skin diseases such as discoid lupus erythematosus, lichen planus.

Multiple eruptive milia: appear as crops of numerous milia. Most often affect the face, upper arm, or upper trunk.

Juvenile milia: appear at birth or later in life; and associated with genetic disorders and epidermolysis bullosa.

Milia associated with drugs: rare seen to the use of topical medication, such as corticosteroid, hydroquinone, and 5FU.

Signs and Symptoms

Milia are neither itchy nor painful and appear as 1–2 mm pearly white, dome-shaped bumps.

The most common locations for primary milia:

· Around the eyes, cheeks, nose, and forehead in adults and infants

· inside the mouth(gums & palate) of infants; and are called Epstein’s pearls.

The most common locations for secondary milia:

· Anywhere on the body where another skin condition exists, particularly on the backs of the hands

· On the faces of people who have had a lot of damage from sun exposure

What is the treatment of milia?

Milia do not need to be treated unless cosmetically undesired for the patient. They are usually harmless and with time resolve on their own. 

Medical treatment:

Topical retinoid cream such as tretinoin or adapalene may be helpful for widespread lesions.

Minocycline has been shown to improve milia en plaque.

Chemical peels or microdermabrasion or dermabrasion: series of sessions are required to be effective for very extensive milia.

Cryotherapy can be applied to destroy the lesions 

Surgical removal by de-roofing using a sterile needle or blade and the contents squeezed out.

Radiofrequency device to the destroyed top layer of skin and curettage.

Laser ablation by co2 or erbium YAG is a recent and effective method to remove extensive milia.

However, milia are found in the outer layers of skin and are difficult to remove. Do not make an attempt to remove them at home as it may leave a mark or scar. The best method of removal of milia is by Ellman radiofrequency device or laser.

How and from which condition milia to be differentiated?

Milia has a characteristic appearance as tiny pearly white bumps, usually seen on cheeks, 

nose, eyes, forehead, neck, and chest areas. 

Milia should be distinguished from other types of a cyst, white comedones, and syringomas. Colloid milia are golden colored lesions and predominantly occur on cheeks and temples, associated with excessive exposure to sunlight. White comedones are distributed on cheeks, chin, hairline, and lodged much deeper into the skin.

Dermatoscopy is the best tool to distinguish milia-like cysts.

Skin biopsy rarely performed to differentiate and show a small epidermoid cyst coming from a vellus hair follicle

What is the treatment of milia?

Milia do not need to be treated unless they are a cause for concern for the patient. They often clear up by themselves within a few months. Where possible, further trauma should be minimized to reduce the development of new lesions.

The lesion may be de-roofed using a sterile needle or blade and the contents squeezed or pricked out.

They may be destroyed using diathermy and curettage, or cryotherapy.

For widespread lesions, topical retinoids may be helpful.

Chemical peels, dermabrasion, and laser ablation have been reported to be effective when used for very extensive milia.

Milia en plaque may improve with minocycline (a tetracycline antibiotic).

Overview

Milia are commonly found on the skin of people of all ages. They are formed when keratin (a substance produced by the skin) becomes entrapped beneath the outer layer of the skin, forming a tiny cyst. An individual milium (the singular of milia) is formed at the base of a hair follicle or sweat gland. 

Milia can be categorized as either primary or secondary. Primary milia are formed directly from entrapped keratin and are usually found on the faces of infants and adults. Secondary milia are also tiny cysts and look similar, but these develop after something clogs the ducts leading to the skin surface, such as after an injury, burn, or blistering of the skin.

Who’s at risk?

Milia can occur in people of all ages, of any ethnicity, and of either sex. Milia are so common in newborn babies (occurring in up to 50% of them) that they are considered normal.

Secondary milia may appear in affected skin of people with the following:

· Blistering skin conditions, such as bullous pemphigoid, epidermolysis bullosa, and porphyria cutanea tarda

· Burns

· Blistering injury to the skin, such as poison ivy

· Following skin resurfacing procedures such as dermabrasion or laser resurfacing

· Following long-term use of steroid creams

· Chronic sun damage

Self-Care Guidelines

When to Seek Medical Care

See a dermatologist or your general physician for evaluation if you notice any new bumps on the skin.

Treatments Your Physician May Prescribe

If the diagnosis from the doctor is primary milia in an infant, no treatment is necessary, as the bumps will go away on their own within a few weeks.

Primary or secondary milia in an adult may disappear on their own, but your doctor may treat you with one of the following:

· Piercing each milium with a sterile lancet or scalpel followed by removal of the cyst material with a tool called a comedone extractor

· Topical retinoid creams such as tretinoin, tazarotene, or adapalene

· A series of acid peels or microdermabrasion procedures at the dermatologist’s office

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