What is the recommended treatment for milia in newborns?

Management of Milia in Newborns

No treatment is necessary for milia in newborns as they typically resolve spontaneously within the first few months of life. 1, 2

What Are Milia?

Milia are small, benign, white keratinous cysts measuring 1-4 mm that result from the immaturity of skin structures 1, 3. They are extremely common in newborns and can be differentiated from neonatal acne by their presence at birth 2.

Clinical Approach

Assessment

• Milia appear as small, white or yellowish, firm papules typically found on the face, particularly on the nose, chin, and cheeks
• They are present at birth, unlike neonatal acne which develops later
• No surrounding erythema or inflammation is typically present

Management Recommendations

1. Observation and Reassurance

   • Milia are benign and self-limiting
   • Spontaneous resolution typically occurs within the first few weeks to months of life
   • Parental reassurance is the cornerstone of management 1

2. Skin Care

   • Gentle cleansing with water alone or with a non-soap cleanser 2-3 times per week 4
   • Apply bland emollient after bathing to maintain skin barrier function 4
   • Avoid harsh soaps, excessive washing, or attempts to express the contents

3. When to Consider Referral

   • Unusual presentations (extensive, persistent beyond 3-4 months)
   • Signs of infection (surrounding erythema, tenderness)
   • Association with other skin or systemic abnormalities
   • Parental anxiety despite reassurance

Important Considerations

What NOT to Do

• Do not attempt to express or manipulate the milia as this may cause inflammation, scarring, or infection
• Avoid using over-the-counter acne medications or other topical treatments
• Do not perform any destructive procedures (e.g., needle extraction, curettage) as these are unnecessary and potentially harmful

Special Circumstances

• Profuse or persistent congenital milia may occasionally be associated with certain inherited disorders, though this is rare 5
• Milia en plaque is an extremely rare variant that has been reported in newborns 6

Parent Education

• Explain that milia are normal and common in newborns
• Emphasize that no treatment is necessary
• Provide guidance on general newborn skin care:
  • Bathing with water alone or non-soap cleanser 2-3 times weekly 4
  • Application of bland emollients after bathing 4
  • Avoidance of harsh products or excessive manipulation of the skin

By following these recommendations, parents can be reassured that milia will resolve without intervention while maintaining good general skin care practices for their newborn.