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Traitements grains milium.

Milium Cysts: How to Get Rid of Them?

Milium cysts are benign formations that occur due to the accumulation of dead cells trapped under the skin, which then harden. In the vast majority of cases, milium cysts fade and disappear on their own. Therefore, removing them could be considered unnecessary, especially in infants. However, some people may find them unsightly, and it is possible to have them removed after evaluation by a dermatologist. Let's explore the various techniques that are available.

Method #1: Perform a mechanical extraction of milia.

Themechanical extraction of a milium grain is performed by a health professional to ensure that the procedure is carried out safely. This technique involves making punctures on the milium grains using a needle, then manually expelling the content with a comedone extractor, a curette, or a cotton swab.

The primary advantage of this method is that it is quick and the results are nearly instantaneous. Numerous studies have shown that this technique does not leave permanent scars after extraction and the risk of milia recurrence is minimal. However, we remind you that it is strongly advised against piercing a milium grain by yourself, as you risk infections.

Method #2: The topical application of retinoids for the removal of milia.

Topical retinoids are also used, particularly in cases of plaque milia. They help to peel off the keratin plug in the milium grain by stimulating the proliferation of free corneocytes, which results in the expulsion of the microcyst. Their effectiveness has been scientifically proven.

Indeed, Kay S. KANE and her colleagues found that the topical application of a 0.025% tretinoin cream every night for six weeks on a child with milia on the nose significantly reduced their number. Complete disappearance was observed after eight weeks and was maintained one year later.

This technique does not result in scarring, has no particular side effects, and allows for a complete and lasting resolution. However, it should be noted that products containing tretinoin are generally medications that require a medical prescription. Like all medications, they can cause adverse effects and are subject to usage precautions.

These details are particularly dependent on the proposed concentrations (0.025%, 0.5%, and 0.1%), and other potentially unsuitable compounds in the preparations available on the market. Therefore, please inform yourself before use if you are pregnant, nursing, or considering use on your child. Discuss it with your doctor or pharmacist if you have the slightest doubt.

Method #3: Utilizing cryotherapy to eliminate milia.

Cryotherapy involves inducing a targeted destruction of tissues by cooling the skin and freezing the cells. Liquid nitrogen is the most commonly used cryogenic agent. Dermatologists apply liquid nitrogen to milia using a cotton swab or a spray. The milia then peel off.

In a study, Guiseppe NOTO observed that a 75-second session of cryotherapy on a woman with milia made them disappear within eight weeks of healing, with no recurrence two years later.

The method does not require local anesthesia. You will only feel a slight burning sensation for a few minutes, but the procedure is not painful. This technique is simple and safe. It does not particularly require post-operative care, only to avoid excessive sun exposure. However, cryotherapy on milia is not as commonly practiced as extraction.

Method #4: Milia and CO2 Laser Ablation.

Less common methods of milia removal include the use of a CO2laser. It employs pulses of laser light. These beams penetrate the skin's surface, where the water in the skin cells absorbs them. The epidermis is then vaporized. The dermis warms up, stimulating the growth of collagen fibers. Within a few days, the skin heals and becomes smooth.

The ablation is performed under local anesthesia. It is easy to perform and allows for the treatment of multiple lesions quickly. However, it can cause sensations of burning, redness in the affected area, and skin discomfort for the following two to three months. Moreover, the healing process can last up to two weeks and a sun protection is essential for the six months following the ablation.

Method No. 5: Opting for Electrodessication on Milia.

Electrodessication represents an option that involves using a specialized needle to deliver an electric current into the keratinized center of a milium grain. The electric current causes the breakdown of the microcyst and its reintegration into the body, and the milia fall off after one or two days.

This technique is quick and efficient. While it may seem a bit intimidating, it is a safe procedure. However, the scientific evidence on the use of electrodessication on milia is somewhat limited.

Method #6: Taking antibiotics to combat milia.

Antibiotics, such as the minocycline, can be used to eliminate milia. This is a tetracycline family antibacterial antibiotic in capsule form, which also has anti-inflammatory activity by inhibiting the expression of pro-inflammatory cytokines.

Studies have shown that taking 100 mg of minocycline orally per day following the application of a retinoid cream can completely eliminate milia within a month. However, the mechanism of action of minocycline on milia remains unknown.

It is important to note that since June 2012, medications containing minocycline are no longer recommended for the treatment of acne, as they can lead to potentially severe allergic skin reactions, including rashes, fever, and swollen lymph nodes. Therefore, it would be prudent to discuss this with your doctor or pharmacist before using this medication.

Note : Furthermore, if you apply corticosteroids to your skin over a long period and notice a flare-up of milia, consult your doctor to see if a change in treatment is necessary. Indeed, studies have shown that the long-term topical application of corticosteroids could promote thedevelopment of milia.

Let's recall that milium cysts disappear on their own in the vast majority of cases and that no treatment is necessary.

Sources

  • AL-SABAH H. & al. Milia en plaque: a new site. International Journal of Dermatology (2000).

  • Traitement abrasif du visage par laser CO2 ultra pulsé ou scanné. Société Française de Dermatologie (2003).

  • BERK D. R. & al. Milia: A review and classification. Journal of the American Academy of Dermatology (2008).

  • FERNÁNDEZ-JORGE B. & al. Variants of milia successfully treated with CO2 laser vaporization. Journal of Cosmetic and Laser Therapy (2010).

  • KANE K. S. & al. Milia en plaque of the nose: Report of a case and successful treatment with topical tretinoin. American Academy of Pediatrics (2014).

  • NOTO G. Milia en plaque. Dermatological Cryosurgery and Cryotherapy (2016).

  • CRANWELL W. C. & al. Optimising cryosurgery technique. Australian Family Physician (2017).

  • WINE LEE L. & al. Successful treatment of facial milia in an infant with orofaciodigital syndrome type 1. Pediatric Dermatology (2017).

  • Les traitements de l'acné par voie orale. VIDAL (2022).

  • GALLARDO AVILA P. & al. Milia. StatPearls (2023).

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