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INTRODUCTION

Milia are benign superficial white-yellow keratinaceous cysts that typically present on the eyelids, forehead, and face but may present anywhere (Fig. 45.1). They occur at all ages and are very common.

Figure 45.1

Small milia on face of a 37-year-old female

EPIDEMIOLOGY

Incidence: very common

Age: any age; most common in newborns and adults

Race: none

Sex: equal

Precipitating factors: These are most frequently sporadic lesions but they can be associated with subepidermal blistering diseases such as porphyria cutanea tarda, epidermolysis bullosa acquisita, varicella zoster virus, bullous pemphigoid, and bullous lichen planus. They are also associated with skin trauma such as abrasions, burns, dermatologic surgery, ablative and nonablative fractional resurfacing, CO2 resurfacing, and radiation therapy. They may also occur following treatment with topical 5-fluorouracil, topical corticosteroids, and microdermabrasion

PATHOGENESIS

Milia are believed to be retention cysts derived from vellus hair follicles. Milia secondary to trauma or bullous diseases arise from ectopic hair follicles.

PATHOLOGY

They represent small epidermoid cysts and feature characteristic stratified squamous epithelium with laminated keratin debris. A granular layer is present in the cyst wall.

PHYSICAL LESIONS

Milia present as 1 to 4 mm superficial white-yellow cysts that most commonly appear on the eyelids, cheeks, and forehead.

DIFFERENTIAL DIAGNOSIS

Their clinical appearance is characteristic.

LABORATORY EXAMINATION

None.

COURSE

They can present at any age and do not resolve without intervention.

KEY CONSULTATIVE QUESTIONS

Is there any history of blistering or trauma?

MANAGEMENT

There is no medical indication to treat milia. The cosmetic appearance, however, may displease some individuals.

TREATMENT

  • Incision and expression: treatment of choice (Fig. 45.2)

Figure 45.2

(A) Lancet piercing a milium on the left lower anterior neck of a patient. (B) Comedone extractor extruding keratinaceous debris from milium. (C) Postprocedure resolution of milium after comedone extraction

    • – Local anesthesia may be required.

    • – Incision with a #11 blade and removal of keratinaceous debris with pressure from comedone extractor, microvascular forceps, or cotton swab tips.

    • – The procedure is fast, simple, and effective.

  • Topical medications

    • – Topical tretinoin can be effective for multiple milia.

  • Other treatments

    • – Electrical fulguration.

    • – Ablative or fractional ablative lasers can be effective but are far more expensive with a higher rate of side effects and recovery ...

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