How to treat scrotal millia?

Treatment of Scrotal Milia

The most effective treatment for scrotal milia is extraction with a sterile needle or blade, followed by expression of the cystic contents. 1

What Are Scrotal Milia?

• Milia are small (1-4 mm), benign, white keratinous cysts that can appear spontaneously or secondary to other conditions 2
• They may be present transiently in both treated and untreated conditions affecting the genital area 1
• While commonly found on the face, milia can also develop on the scrotum, where they appear as small white or yellowish papules 2

Treatment Options

First-Line Treatments:

• Manual extraction: Using a sterile needle or small blade to create a tiny opening, followed by gentle expression of the keratinous contents 3
• Cryotherapy with liquid nitrogen: Can be effective for individual lesions, similar to treatment approaches used for genital warts 1
• Topical retinoids: May help by increasing cell turnover and preventing keratin plugging 2

For Multiple or Resistant Lesions:

• Dermabrasion: Has shown complete regression of milia en plaque (a rare variant with multiple milia in an erythematous base) with follow-up at 6 months 3
• Electrodesiccation: Can be used for individual lesions that are resistant to other treatments 1
• Curettage: Similar to techniques used for other small benign lesions 1

Clinical Considerations

• Scrotal milia are benign and often asymptomatic, so treatment is primarily for cosmetic concerns 2
• Before treatment, it's important to confirm diagnosis with visual examination to distinguish from other scrotal conditions 4
• Ultrasound may be used if there is any doubt about the diagnosis, especially to rule out other scrotal masses 5
• Multiple eruptive milia can be cosmetically troublesome and more difficult to treat than isolated lesions 2

Treatment Approach Algorithm

1. Confirm diagnosis: Visual examination is usually sufficient; ultrasound if uncertain 5
2. For isolated lesions: Begin with simple extraction using a sterile needle 3
3. For multiple lesions: Consider cryotherapy or electrodesiccation 1
4. For extensive or resistant cases: Consider dermabrasion or referral to dermatology 3

Potential Complications and Cautions

• Avoid aggressive treatments that could damage surrounding scrotal tissue, as the scrotum has special functions including temperature regulation for spermatogenesis 6
• The scrotal skin is thin and highly vascular, so gentle techniques are preferred to avoid scarring 6
• Infection is a potential complication of any invasive procedure in this area; maintain sterile technique 7

Follow-up Recommendations

• Most cases resolve with a single treatment session 3
• Recurrence is possible, especially with multiple eruptive milia 2
• If milia persist or recur frequently, consider evaluation for underlying skin conditions 1

Remember that while milia are benign, any persistent or changing lesions on the scrotum should be evaluated to rule out more serious conditions 4.