From the Guidelines
Milia can be effectively treated with topical retinoids, such as tretinoin (0.025-0.1%) applied nightly, which promote cell turnover and prevent new milia formation. This approach is supported by the understanding that milia often form when dead skin cells and oils become trapped beneath the skin's surface, creating small, white cysts 1. While the provided study primarily focuses on the management of lichen sclerosus, it mentions milia as a transient condition that may be present in treated and untreated disease, highlighting the importance of gentle skin care and potentially the use of retinoids to manage such skin conditions.
Some key points to consider in the treatment of milia include:
- Gently exfoliating the skin with a washcloth to remove dead skin cells
- Using retinoid creams to promote cell turnover
- Considering professional treatments like extraction by a dermatologist for persistent milia
- The potential use of chemical peels containing glycolic or salicylic acid to remove dead skin cells and prevent new milia formation
- Microdermabrasion as an option for physically exfoliating the skin's surface in stubborn cases
It's crucial to avoid picking or attempting to pop milia at home, as this can lead to scarring or infection. Instead, opting for evidence-based treatments like topical retinoids can help in managing milia effectively, improving the quality of life by reducing the appearance of these small, white cysts. The mention of milia in the context of lichen sclerosus treatment 1 underscores the importance of considering the broader skin health context when addressing specific dermatological conditions.
From the FDA Drug Label
For Dermatologic Use: Salicylic Acid 6% is a topical aid in the removal of excessive keratin in hyperkeratotic skin disorders including verrucae, and the various ichthyoses (vulgaris, sex-linked and lamellar), keratosis palmaris and plantaris keratosis pilaris, pityriasis rubra pilaris, and psoriasis (including body, scalp, palms and soles). The FDA drug label does not answer the question.
From the Research
Treatment Options for Milia
- Manual extraction and topical medications such as tretinoin have been shown to be effective in treating milia, as demonstrated in a case study where an infant with orofaciodigital syndrome type 1 was successfully treated with manual extraction and tretinoin 2.
- Combination therapies, such as superficial peels with salicylic acid and post-peel retinoids, have been found to be effective in improving photodamage and acne vulgaris, which may also be beneficial for treating milia 3.
- CO2 laser treatment has been used to successfully treat milia-like idiopathic calcinosis cutis of the forehead in an adult without Down's syndrome, providing a valuable alternative to surgical excision 4.
- Short contact therapy with tretinoin, clindamycin, and glycolic acid gel has been shown to be effective and well-tolerated in the treatment of mild to moderate acne, and may also be beneficial for treating milia 5.
- Erbium:YAG laser ablation has been used to successfully treat periocular milia en plaque, providing a safe and effective treatment option for this condition 6.
Considerations for Treatment
- The choice of treatment for milia will depend on the individual case and the severity of the condition.
- Topical medications and manual extraction may be sufficient for mild cases, while more severe cases may require more invasive treatments such as laser ablation.
- It is essential to consult a dermatologist to determine the best course of treatment for milia.