Treatment of Milia in Infants
No treatment is necessary for milia in infants as they typically resolve spontaneously within the first few weeks to months of life.
What are Milia?
Milia are small, white or yellowish, keratin-containing dermal cysts that commonly appear on the face of newborns, particularly on the nose, chin, cheeks, and forehead. They are benign and result from the retention of keratin within the dermis.
Clinical Presentation
- 1-2 mm white or yellowish papules
- Commonly found on the face (nose, chin, cheeks, forehead)
- Not associated with inflammation or erythema
- May appear in clusters or as isolated lesions
Natural History
Milia in infants are transient and benign 1. They typically resolve spontaneously within the first few weeks to months of life without any intervention. This self-resolving nature is well-documented in the literature, with most cases clearing completely by 3-4 months of age.
Management Approach
Primary Management: Observation
- Watchful waiting is the standard of care for infantile milia
- No active intervention is required in most cases
- Parents should be reassured about the benign and self-limiting nature of these lesions
Skin Care Recommendations
While waiting for spontaneous resolution:
- Gentle cleansing with water alone or with a non-soap cleanser 2
- Avoid harsh soaps, scrubbing, or picking at the lesions
- Apply bland emollients if the surrounding skin appears dry
When to Consider Further Evaluation
While most cases are benign and transient, consider further evaluation if:
- Milia are unusually profuse, persistent beyond 6 months, or increasing in number
- Associated with other cutaneous findings or systemic symptoms
- Family history of persistent milia (may suggest rare genetic conditions)
Special Considerations
Differential Diagnosis
It's important to distinguish milia from other neonatal skin conditions:
- Miliaria (heat rash) - appears as tiny red bumps, often in skin folds, associated with overheating
- Neonatal acne - includes inflammatory papules and pustules, often with surrounding erythema
- Transient neonatal pustular melanosis - vesicopustular lesions that rupture leaving hyperpigmented macules
Rare Associations
In rare cases, profuse congenital milia may be associated with certain genetic disorders 3, 4:
- Bazex-Dupré-Christol syndrome - X-linked dominant condition with follicular atrophoderma, hypotrichosis, and early basal cell carcinomas
- Other genodermatoses
Unusual Presentations
Milia en plaque is an uncommon variant that presents as an erythematous plaque with numerous milia. While typically seen in adults, rare congenital cases have been reported 5, 6. These unusual presentations may warrant dermatology consultation.
Parental Education
Parents should be counseled that:
- Milia are common, affecting up to 50% of newborns
- They are not caused by poor hygiene or skin care
- They do not cause discomfort to the infant
- No treatment is necessary as they will resolve on their own
- Attempting to express or remove milia can lead to scarring and should be avoided
Remember that parental reassurance is often the most important aspect of management for this common and benign condition.