Disease Description (Causes and Symptoms)
- Definition: A milium is a superficial, small keratin cyst that mainly occurs on the face (especially around the eyes, cheeks, and eyelids) as a round, white or yellow papule approximately 1–2 mm in diameter.
- Causes/Pathophysiology:
- Primary: Forms through the accumulation of keratin that develops spontaneously in the hair follicle or epidermal area.
- Secondary: Occurs when damage to the skin structure caused by blisters, burns, dermabrasion, trauma, or chronic use of topical steroids blocks the excretory pathways of hair follicles, sweat glands, or the epidermis.
- Main symptoms: There is little to no pain or inflammation, and the main symptom is a cosmetic concern (a small, firm, painless papule). If infected, redness, pain, and discharge may occur.
Treatment Methods
- Conservative management
- Since milia in newborns and some primary milia often disappear on their own, observation may be chosen.
- Procedural treatment (mainly for cosmetic purposes)
- After making a tiny opening with a sterile blade (sterile needle), the contents are expressed with a comedone extractor or removal tool (performed in a clinic).
- A small incision followed by curettage (scraping) or electrodessication, etc.
- Topical medication
- Topical retinoids (e.g., tretinoin) may be helpful for chronic cases or to prevent recurrence, but they are not standard in all cases.
- Treatment of complications
- If infection is suspected, antibiotics (topical or oral) may be prescribed.
- Lifestyle management
- Avoid unclean practices such as squeezing them yourself, as these increase the risk of scarring and infection.
- Prevent secondary milia through appropriate wound care after dermabrasion, laser procedures, or chemical peeling.
- Precautions
- If someone who is not a medical specialist forcibly squeezes the lesion or applies excessive force, scarring, hyperpigmentation, or infection may occur.
- Milia may develop more easily in areas of skin atrophy caused by long-term use of topical steroids, so use steroids according to a doctor’s instructions.
- Hyperpigmentation, scarring, and recurrence are possible after the procedure.
Checklist Before an Outpatient Visit (Including Example Questions)
- Items and records to prepare
- List of currently used medications (including topical ointments) and allergy information
- Information about previous dermatology visits or prior procedures (dermabrasion, laser treatment, burns, etc.)
- When the symptoms began and their progression (when they started, changes in number, changes in size, and whether pain or discharge is present)
- Skin care products currently being used (moisturizer, sunscreen, steroid ointment, etc.)
- Photos of the lesions, if possible (from various angles and in different lighting)
- Examples of information to tell the doctor during the visit
- “When did this lesion first appear?” (Prepare in advance)
- “Have you recently had a skin procedure or trauma?” (Prepare in advance)
- “Are you currently applying any ointment or using any treatment medication?” (Prepare in advance)
Examples of General Questions to Ask the Doctor
- Does this lesion definitely need to be removed, or is it okay to leave it alone?
- What is the risk of scarring or hyperpigmentation after removal?
- How likely is it to recur?
- Are there any care methods I can use at home or any actions I should avoid?
- Could other medications I am using (such as topical steroids) have an effect?
Examples of Condition-Specific Questions
- Adult milia: “Multiple milia keep recurring. Are there any preventive treatments or lifestyle habits you recommend to reduce recurrence?”
- Newborns/infants: “Do neonatal milia usually disappear within a few weeks? Is there an age restriction when removal is necessary?”