Milia – Types, Causes & Symptoms, Diagnosis, Treatment and Prevention

Infants are most frequently affected by milia, however anyone can develop milia of all forms at any age. When they are born, milia is present in around half of all healthy infants. Milia can develop later in childhood in preterm infants.

Milia

Milia are highly frequent, benign, keratin-filled epidermoid cysts that can affect people of any age, from newborns to the elderly. 

• Primary milia can develop in children and adults but are more common in infants, where they are congenital. Primary milia arise spontaneously. The face is the most prevalent area of the body where primary milia develop on skin with vellus hair follicles.
• Eccrine duct injury is the cause of secondary milia.
• Multiple eruptive milia and milia en plaque are different things.

Read More:- https://www.ncbi.nlm.nih.gov/books/NBK560481/

Symptoms Of Milia

• Milia are superficial, homogeneous, domed lesions that range in colour from pearly white to yellowish and are 1-2 mm in diameter.
• Milia can appear everywhere on the body, including the genitalia, although they most frequently appear on the face, where they are particularly noticeable on the cheeks and eyelids.
• They may be irritating but are typically asymptomatic.

PRIMARY MILIA:-

• Infants with primary milia typically have lesions on their faces, particularly on their cheeks, nose, and eyes. On the scalp, face, and upper body, they might be more pervasive.
• The oral equivalents of milia are assumed to be congenital oral inclusion cysts, such as those observed on the mucosa (Epstein’s pearls) and palate (Bohn’s nodules).
• The eyelids, cheeks, forehead, and genitalia are where primary milia are most frequently found in both children and adults. They can go away in a couple of weeks or linger for months or longer.
• Juvenile milia can develop later in life or be present at birth. They could be linked to other hereditary diseases.

MILIA EN PLAQUE:-

• Small papules may appear unilaterally or bilaterally in the postauricular region on a discrete, erythematous plaque.
• They typically appear behind the ears, but they can also appear on the cheeks, jaw, or eyelids. There have been reports of lesions on the pinna and submandibular plaques.
• They may be linked to other skin conditions such lichen planus, discoid lupus erythematosus, and pseudoxanthoma elasticum, which specifically affect middle-aged women.

MULTIPLE ERUPTIVE MILIA:-

• Milia crops develop over the course of a few weeks to months.
• They typically affect the upper arms, upper trunk, and face.

SECONDARY MILIA:-

Depending on the underlying ailment, they can be found anywhere on the body:

• Disease: post-bullous, commonly epidermolysis bullosa and porphyria cutanea tarda, although it can also happen after other skin disorders, like contact dermatitis or lichen sclerosis.
• Topical steroids, 5-fluorouracil, ciclosporin, and penicillamine are all drugs which lead to milia.
• Milia in youngsters is frequently caused by traumatic abrasions. They can also happen after radiation, dermabrasion, or second-degree burns, for instance.

Causes of Milia

Newborns have different causes than older kids and adults have.

NEWBORNS:-

Milia in infants has no recognised cause. It’s frequently confused for baby acne, which is brought on by the mother’s hormones.

Milia doesn’t lead to edema or irritation like newborn acne does. Baby acne doesn’t often present until two to four weeks after delivery, although infants that have milia typically have it from birth.

ADOLESCENTS AND ADULTS:-

Milia are often linked to some form of skin injury in older children and adults. This might comprise:

• blistering brought on by a skin ailment, such as porphyria cutanea tarda (PCT), cicatricial pemphigoid, or epidermolysis bullosa (EB), or blistering injuries, including burns from poison ivy.
• permanent solar damage
• long-term steroid cream usage
• techniques for resurfacing the skin, like dermabrasion or laser resurfacing
• Milia may also appear if the skin stops naturally exfoliating. Aging may cause this to occur.

Diagnosis of Milia

The appearance of the cysts, their occurrence, symptoms, etc. can all be used by the doctor to make a diagnosis of milia.

• Inspection of the body:- Doctors inspect the cysts physically to identify whether they are milia or another skin disorder.
• Biopsy of skin lesions:- The area of the skin lesion where the cysts have developed is sampled. This aids in researching and examining milia cysts and their development. Milia biopsies, however, are uncommon and only performed in severe circumstances.

Tests 

• Simple milia can be diagnosed based solely on the clinical presentation, hence no additional testing is necessary.
• A biopsy may be required in elderly individuals with sun-damaged skin to rule out nodular elastosis of the skin (Favre-Racouchot syndrome). A biopsy is advisable if milia en plaque is suspected in order to confirm the diagnosis.

Treatment of Milia

For newborns, regular skin care is advised. This entails washing their faces with warm water and mild baby soap every day, patting their skin dry, and refraining from using lotions or oils on their skin.

In order to prevent infection, it is typically advised that milia lumps be left alone and not squeezed or cleaned.

If parents have any worries about how their child’s skin looks, whether a rash is present, or have any other queries, they should speak with their child’s doctor.

Treatment Of Milia Under The Eyes

In a few months, some milia patients resolve on their own without any medical intervention. The majority of persons who had milia as infants no longer do.

There is no clear standard for therapy, though this is not always the case. Milia under the eyes and on the face are not hazardous, but many people worry about their appearance.

Never squeeze a milium the same way you would a pimple. The skin will get irritated, and the sensitive skin around may become damaged.

The majority of at-home milia treatments use chemical peels or mild exfoliation. Before utilising these methods, especially near the eyes, it is crucial to see a doctor. A physician might also provide in-office removal.

CHEMICAL EXFOLIANTS:-

A dermatologist might occasionally advise a chemical peel. However, it’s crucial to keep in mind that milia behind the eyes is not likely to be eliminated by over-the-counter exfoliative chemicals.

Chemical peels frequently use the following active ingredients:

• Acid lactate
• Glucosamine acid
• acid salicylate

However, because the area around the eye is so delicate, more caution must be exercised. A dermatologist should always be consulted before using any chemical exfoliants.

EXPERT ALTERNATIVES:-

Milia under the eyes may be treated by a dermatologist utilising methods they have available in their practise. These comprise:

Extraction:-

Dermatologists frequently perform a procedure known as a milium extraction in which they scrape away a portion of the skin covering the cyst using a tiny scalpel or needle.

They can carefully move the keratin out by using this method to open the pore. People will then need to take precautions to avoid the milia from returning.

Laser Ablation:-

A dermatologist can open a pore by focusing a small laser on the milium during laser ablation.

Cryotherapy:-

Cryotherapy might be a beneficial treatment option in some circumstances. Liquid nitrogen is used in cryotherapy to freeze and demolish the milia.

This might not be the ideal solution for milia in this location, though, as the skin beneath the eyes is delicate. It could hurt and result in pigmentation changes or scars.

Deroofing:-

When a sterile needle is inserted into the milia to remove the contents of the cyst. 

Diathermy:-

When milia is destroyed by producing extreme heat by high frequency electric currents. 

Prevention of Milia 

Milia cannot be completely avoided. Adults who take proper care of their skin can avoid developing milia and other disorders.

• Moisturise and use sunblock. When you are exposed to too much sun, milia frequently occurs. The dead skin cells are more difficult to remove as your skin turns leathery.
• Your skin can replace itself the way it should by staying soft and flexible with sunscreen and moisturiser. Even in the winter and when spending extended periods of time indoors close to windows, wear sunscreen.
• Avoid applying thick lotions or ointments. These may irritate your skin and clog your pores, limiting natural exfoliation.
• Keep your face squeaky clean. Your pores will clog as perspiration and dirt accumulate. Acne and skin issues may result from this.
• Your skin will be able to exfoliate if you clean off the daily filth from your face. To assist your skin shed the dead cells, keep your face clean.
• Start out early. Teach your children the value of protecting their skin if you or they are prone to milia outbreaks. As they get older, teach them how to shield themselves from the sun’s rays by using sunscreen, donning hats, and wearing other protective clothes.

Summary of Milia

Milia are microscopic cysts that form under the skin as a result of innocuous keratin buildups. They frequently appear around and under the eyes as well as on the face.

Milia are not pimples, and trying to pop one can make it worse by leaving scars. For the milia to go away, the pores must clean out the accumulated keratin.

Deeper milia or those in delicate regions, such the area around the eyes, might be treated professionally to help get rid of them.

A comprehensive diagnosis and discussion of treatment options should be had with a physician or dermatologist by anyone who has recurrent milia in the same location.

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Frequently asked questions

Special Note

The tiny white pimples that appear on your newborn’s skin are unimportant. They are typical. Milia is a benign disorder that briefly alters your skin’s texture and appearance. After a few weeks, the illness normally resolves on its own without the need for therapy. If your skin or the skin of your child doesn’t improve after several weeks, consult your healthcare practitioner.