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What to do when a milium cyst doesn't go away?

Generally, milia tend to disappear spontaneously. However, they may persist. Learn how to respond to a milium that does not resolve itself.

Summary
Published March 25, 2024, by Kahina, Scientific Editor — 4 min read

Can a milium persist?

A milium, or milia in plural, is a small white cyst that develops under the skin, often appearing on the face. These skin cysts result from the accumulation of dead cells with keratin, a skin protein, which gets trapped under the surface instead of naturally shedding. Milia can present as isolated spots or in clusters, referred to as plaque milia. They are benign and disappear naturally over time without intervention in most cases.

However, there are instances where milia persist. This is particularly the case for what are known as secondary milia. These are localized cysts associated with other events. They can be related to a disease, such as blister-associated milia linked to epidermolysis bullosa, a disorder characterized by the presence of subcutaneous blisters. Their appearance can also follow trauma (skin abrasion or sunburn, for example). Secondary milia can be associated with conditions, such as contact dermatitis or phototoxic reactions in extremely rare situations.

What behavior should be adopted if a milium does not disappear?

If the milium persists, it would be crucial to get in touch with your dermatologist. The diagnosis of a milium is clinical and takes place in their office. Here are the typical steps of the diagnostic process.

  1. Visual Examination: The dermatologist examines the areas of the skin where milia are present. They are described as small white to yellow papules, with a diameter less than 3 mm, shaped like a smooth dome.

  2. Medical History: The dermatologist may ask questions about the patient's medical history, including any pre-existing skin conditions, medications taken, skincare products used, and family history of milia, due to a possible genetic origin that has been described.

  3. Differentiation: The dermatologist can differentiate milia from other similar skin conditions, such as epidermoid cysts or whiteheads. This distinction can be made based on the appearance, location, and patient history.

In some instances, the dermatologist may recommend additional tests to corroborate the diagnosis, such as the incision and drainage of the keratinous content of the milia. Moreover, persistent and widespread milia may necessitate the investigation of other causes, such as an underlying genodermatosis (genetic skin disease), particularly when other clinical signs are present. Once the diagnosis is confirmed, the doctor can discuss the treatment options with the patient if necessary.

Among the treatments typically prescribed by dermatologists, we can find theextraction using a milia extractor, which is a mechanical technique, the intake of antibiotics such as minocycline, and the application of retinoids to the affected areas. More modern techniques like theCO laser ablation2, electrodessication, and cryotherapy can also be considered.

Do not attempt to remove milium cysts yourself. This could lead to scarring or infections. It is best to consult with a qualified healthcare professional.

Sources

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

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

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