What is the treatment for milia?

Treatment for Milialia (Milia)

The primary treatment for milia is extraction or removal of the cysts using a sterile needle or blade, which provides immediate resolution with minimal risk of scarring. This approach is most effective for isolated lesions that are cosmetically concerning.

Understanding Milia

Milia are small, benign, white or yellowish keratinous cysts measuring 1-4 mm that can appear on various parts of the body, most commonly on the face 1. They occur when keratin becomes trapped beneath the skin surface, forming small, dome-shaped bumps.

Types of milia include:

• Primary milia: Occur spontaneously
• Secondary milia: Develop following skin trauma, disease, or medication use
• Multiple eruptive milia: Characterized by sudden onset of numerous lesions
• Milia en plaque: Erythematous plaques studded with multiple milia

Treatment Options

First-line Treatments

1. Extraction/Removal

   • Most effective immediate treatment
   • Performed using a sterile needle, lancet, or blade
   • Creates a small opening in the cyst to express the keratin contents
   • Best performed by healthcare professionals to minimize scarring risk

2. Topical Retinoids

   • Promote cell turnover and can help resolve milia
   • Examples: tretinoin, adapalene, tazarotene
   • Apply thinly to affected areas
   • May cause initial irritation and dryness

3. Chemical Exfoliation

   • Alpha hydroxy acids (glycolic acid, lactic acid)
   • Salicylic acid (beta hydroxy acid)
   • Help remove excess keratin and prevent cyst formation

For Extensive or Recurrent Cases

1. Dermabrasion/Microdermabrasion

   • Physical exfoliation to remove superficial skin layers
   • Can help with multiple lesions

2. Electrodesiccation

   • Uses electrical current to destroy the cyst
   • Effective for stubborn or recurrent milia

3. Laser Therapy

   • CO2 laser can effectively treat multiple milia
   • Particularly useful for milia en plaque

Special Considerations

For Pediatric Patients

Neonatal milia are extremely common and typically resolve spontaneously within the first few months of life 2. No treatment is necessary for these cases unless they persist beyond 3-6 months.

For Milia En Plaque

This rare variant presents as erythematous plaques studded with multiple milia. Treatment approaches include:

• Manual extraction of individual milia
• Minocycline has shown success in some cases 3
• Combination therapy may be required

Prevention Strategies

• Regular gentle exfoliation
• Avoiding heavy, occlusive skincare products and cosmetics
• Proper cleansing to prevent keratin buildup
• Sun protection to prevent skin damage that may contribute to milia formation

Treatment Algorithm

1. For isolated, few milia:

   • Professional extraction is most effective
   • Home care with topical retinoids or chemical exfoliants

2. For multiple, widespread milia:

   • Consider combination of extraction and topical treatments
   • Evaluate for underlying causes or associated conditions
   • Consider dermabrasion or laser therapy for extensive cases

3. For recurrent milia:

   • Assess skincare routine and eliminate potential contributing products
   • Implement regular exfoliation regimen
   • Consider maintenance therapy with retinoids

Cautions

• Avoid attempting extraction at home, which can lead to scarring or infection
• Patch test new topical treatments to avoid irritation
• Be aware that milia may be a sign of certain genetic disorders or skin conditions in some cases
• Consult a dermatologist for persistent or extensive milia

While milia are benign and often resolve spontaneously (especially in infants), treatment is primarily sought for cosmetic concerns in adults. The extraction method provides the most immediate and definitive resolution for individual lesions.