Milia

Milia are benign tiny cysts. They are small sacks containing white, cheesy material derived from either parts of the hair follicle, oil glands, or sweat glands. They usually develop spontaneously, or secondary to trauma (i.e. dermabrasion, radiation therapy), prolonged topical corticosteroid therapy, and following the resolution of various inflammatory conditions.

Presentation:
Milia are small, 1-2 mm, white, dome-shaped bumps typically found on the face, most commonly on the eyelids, cheeks, and forehead. They occur on the face in up to 50% of newborns. Lesions are usually asymptomatic, causing mostly cosmetic concerns. Occasionally, patients may present with eruptive milia, with lesions distributed over the face, neck, shoulders, and chest. This particular presentation of milia may occur as an inherited condition or may be associated with the other causes listed above.

Treatment:
Although milia represent benign lesions and do not necessarily require treatment, they may be treated through simple enucleation (a process whereby pressure is applied over the lesion to express the contents). Destructive methods involving the use of electric current (electrodessication) have also been suggested, in addition to topical retinoid creams (vitamin A derivatives used in the treatment of acne).

References:

George DE, Wasko CA, Hsu S. Surgical Pearl: Evacuation of milia with a paper clip. J Am Acad Dermatol 2006;54:326.
James WD, Berger TG, and Elston DM. “Epidermal Nevi, Neoplasms, and Cysts.” Andrews’ Diseases of the Skin. Tenth Ed. Saunders:Canada, 2006, 633-83.
Langley RGB, Walsh NMG, Ross JB. Multiple eruptive milia: Report of a case, review of the literature, and a classification. J Am Acad Dermatol 1997;37:353-356.

Matthew Smetanick, D.O.
Department of Dermatology
Philadelphia College of Osteopathic Medicine/Frankford Hospital
Philadelphia, Pennsylvannia.