Milia

Overview:

Milia are self-limited, benign lesions that look like little white bumps. They are found on the cheeks, upper lips, nose and forehead. The cysts are usually seen in groups rather than singly. Their size can range from one to two millimeters across. This equates to less than a quarter of an inch in diameter.

The cysts of milia are usually what dermatologists call “multiple superficial inclusion” cysts. They involve the upper part of the follicles of hair. They have keratin inside, and there is not an opening that you can see.

Causes:

Milia are formed by skin not sloughing off normally as it dies, but instead remaining trapped in a surface pocket of the skin. Each individual milium is formed from a sweat gland or a hair follicle. In the milia most seen, which would be in infants, the oil glands may not be developed fully. Milia later in life can occur after a skin trauma or blisters on the skin. These can disrupt and clog up the tubes that lead to the surface of the skin. Secondary milia sometimes also develops in middle aged and aged people with skin that has been damaged by overexposure to the sun.

Secondary milia can occur anywhere on the body where there is already a skin condition, or on the faces of people who were over-exposed to sunlight. As with any type of skin disorder, if you notice a change in a milium or any other skin growth, contact your physician, to rule out skin cancer.

In the United States, about forty percent of newborns will develop milia. It is generally associated with newborns who were carried for the full – or nearly the full - term, more so than for premature infants. The rash will normally appear within four to five days after birth, in babies carried to term. Milia’s manifestations can be delayed from a period of days to a period of weeks in babies born before the full term had elapsed.

Milia appears to occur in every race and in both sexes. In neonatal cases, as noted, it usually appears within several days after birth.

The lesions associated with milia are usually solid and small, and visibly elevated from skin level. They are opalescent and pearly in appearance, and are sometimes referred to as “Epstein Pearls” when they are present on the hard or soft palate.

Treatment:

As far as treatment is concerned, it is not generally required in infants. Most lesions caused by milia disappear by the time an infant is one to two months old. It is not recommended to put ointment or cream on the lesions, as this may only serve to plug them up, which results in them not being allowed to heal properly. Drug therapy is not indicated for those with milia.

In secondary milia, you may be prescribed a topical retinoid cream, or you may have the milia lanced with a sterile scalpel. Fruit acid peels may offer some help for exterminating milia, as can procedures of microdermabrasion at the office of your dermatologist.

Milia isn’t infectious, and it is also non-communicable. You do not need to isolate the child with milia, and there is no need to restrict their activity levels.

First stage milia in infants is considered normal, and there is no way to prevent it, as far as science today knows. To prevent secondary milia, stay out of the sun or use sunscreen during the most intense hours of sunlight (10 AM to 4 PM). Wear long sleeves and long pants, and above all, protect your face with sunscreen and/or by wearing a wide-brimmed hat so that you’re not over-exposed to sunlight.