Milia: Milium, Milia En Plaque…

Milia are very common and may be seen at any age.  It is also referred to as Milium.  Up to 50% of newborns are born with milia.  They are keratinous cysts 1-4 mm in diameter and appear as white lesions over attenuated skin.  There are multiple clinical patterns related to primary causes, appearing spontaneously or secondary, caused by trauma, skin diseases or medications.  They most commonly occur on the face, especially the nose, scalp, upper trunk and proximal extremities.

Milia in teenagers can be explosive and involve most of the facial areas…and tend to be persistent.  Pseudoacne of the nasal crease may be related.  Milia En Plaque (MEP) is a rare disorder characterized by erythematous plaques containing numerous milia…usually on the head and neck regions, particularly the periauricular and periorbital regions.  MEP is most common in middle-aged females.  Secondary milia can develop as a result of blistering diseases such as epidermolysis bullosa, pemphigus, bullous pempigoid, porphyria cutanea tarda, herpes zoster, polymmorphous light eruption, lupus erythematosus, Stevens-Johnson syndrome, contact dermatitis and many other conditions.  Skin trauma may also promote milia formation, such as dermabrasion, chemical peels, ablative laser therapy, skin grafts, tattoos, cryotherapy and radiotherapy.  Medications such as topical steroids, occlusive moisturizers, cyclosporine and 5-fluorouracil have been reported.

Primary milia are small epidermal inclusion cysts derived from the infundibulum of the villus hair (above).  Secondary milia may be derived from eccrine ducts or hair follicles.

TREATMENT:  Milia can resolve spontaneously, but the more the number of lesions, the more patients become motivated to have them treated.  Milia can be removed using a variety of instruments, such as a beveled cutting tipped hypodermic needle, number 11 surgical blade or a comedo extractor.  Anesthesia is not needed.  I have had good results with persistent chronic and recurrent forms by using topical tretinoin (Retin-A).  To read more about milia, click HERE and HERE.