How to treat milia?

Treatment of Milia

The most effective treatment for milia is mechanical extraction using a sterile needle or blade followed by gentle expression of the cystic contents. This direct approach provides immediate cosmetic results for these benign keratinous cysts.

What Are Milia?

Milia are small, white, benign keratinous cysts measuring 1-4 mm in diameter that appear as pearly white dome-shaped lesions 1. They can occur:

• Spontaneously (primary milia)
• Secondary to skin trauma, certain medications, or dermatological conditions
• In various distributions including face, trunk, and occasionally unusual sites like axillae 2

Treatment Options

First-Line Treatment:

1. Mechanical extraction
   • Using a sterile needle or #11 blade to create a small opening
   • Gentle expression of contents with a comedone extractor
   • Provides immediate resolution
   • Most appropriate for isolated or limited lesions

Alternative Treatments:

1. Topical retinoids

   • Helps with epidermal turnover
   • May prevent new milia formation
   • Takes longer to show results than extraction

2. Mild chemical peels

   • Glycolic or salicylic acid
   • Helps exfoliate the epidermis
   • May require multiple sessions

3. Electrodesiccation

   • Using low electrical current to create an opening
   • Followed by expression of contents
   • Useful for multiple lesions

4. Microdermabrasion

   • Physical exfoliation technique
   • May help with widespread milia
   • Multiple sessions typically required

Special Considerations

For Multiple Eruptive Milia:

• More aggressive approach may be needed
• Consider combination therapy with extraction and topical retinoids
• Documented cases show good response to minocycline in some variants 3

For Congenital Milia:

• Often resolve spontaneously within first few months of life 4
• Observation is appropriate unless persistent or extensive
• Consider evaluation for associated conditions if extensive

For Milia Associated with Other Conditions:

• Treat the underlying condition when possible
• Milia may appear during healing of bullous disorders 5
• May require more frequent follow-up

Treatment Algorithm

1. For isolated or few milia:

   • Direct extraction is most efficient

2. For multiple or widespread milia:

   • Consider combination approach:
     • Extraction for immediate improvement
     • Topical retinoids for prevention
     • Consider chemical peels for maintenance

3. For persistent or recurrent milia:

   • Evaluate for underlying causes
   • Consider more aggressive exfoliation
   • Maintenance therapy with topical retinoids

Prevention of Recurrence

• Regular but gentle exfoliation
• Avoid heavy, occlusive cosmetics
• Consider periodic use of topical retinoids in prone individuals
• Sun protection to prevent skin damage that may contribute to milia formation

Remember that while milia are benign, they can be cosmetically bothersome to patients. The treatment approach should focus on effective removal with minimal risk of scarring.