Treatment of Milia
For cosmetically bothersome milia, laser ablation using CO2 fractional laser or erbium:YAG laser provides excellent results with minimal scarring, particularly for periocular lesions, though simple needle extraction or incision with expression remains the most practical first-line approach for isolated lesions. 1
Primary Treatment Approaches
Standard Mechanical Removal
- Manual extraction with a sterile needle or small blade incision followed by expression of the cyst contents is the most straightforward and cost-effective treatment for isolated milia 1
- This approach is particularly suitable for small numbers of lesions and provides immediate results with minimal risk 1
Laser Therapy
- CO2 fractional laser or erbium:YAG laser ablation is highly effective for multiple milia or periocular locations where mechanical extraction may be challenging 1
- Laser treatment offers the advantage of minimal scarring and is especially valuable for cosmetically sensitive areas around the eyes 1
Topical Retinoids
- Topical tretinoin offers an effective non-invasive treatment option, particularly for milia en plaque in pediatric populations 2
- A case report demonstrated successful resolution of milia en plaque of the nose in a 7-year-old boy using topical tretinoin 2
- This approach may require several weeks to months of consistent application but avoids procedural intervention 2
Special Clinical Scenarios
Milia En Plaque
- This rare variant presents as numerous tiny cysts within an erythematous plaque, most commonly in the periorbital region 3
- Treatment options include chemical exfoliating agents, manual extraction, and topical photodynamic therapy, though results are often only partial 3
- Topical tretinoin has shown success in pediatric cases and should be considered as first-line therapy before more invasive approaches 2
Secondary Milia
- Milia developing after bullous diseases (such as bullous pemphigoid) or trauma typically resolve spontaneously and may not require active treatment 4
- Observation is appropriate for secondary milia that develop during treatment of underlying eyelid conditions like blepharitis, as these often resolve without intervention 1
Important Clinical Considerations
Common pitfall: Attempting aggressive treatment of milia that may be part of a genetic syndrome or associated with underlying disease. Multiple eruptive milia can be familial, part of genodermatoses like Basan's syndrome, or idiopathic 5, 6. In such cases, genetic counseling and evaluation for associated features (such as absent dermatoglyphics or acral bullae) should precede cosmetic treatment decisions 6.
Anatomic considerations: Periocular milia require particular care due to proximity to the eye. Laser ablation is preferred over manual extraction in this location to minimize risk and optimize cosmetic outcomes 1.
Patient selection: For patients with extensive or recurrent milia, particularly in challenging anatomic locations, referral to dermatology for laser therapy or consideration of topical retinoid therapy is more appropriate than repeated manual extractions 3, 2.