Everything You Need To Know About Milialar Or Milia

Milialar are small keratin cysts consisting of small white papules found on the cheek and eyelids. Milialar are common on the cheeks of newborns, and secondary milia may occur following skin trauma or inflammation. Milialar cysts are white in colour but can appear bluish on darker skin tones. These bumps are small in size and very distressing due to their appearance. These minute cysts are harmless and require no treatment. They can be removed under topical anesthetic with a sterile needle.

Classification of Milialar

Milia—Milialar cysts may arise either spontaneously (primary Milialar) or secondary to various processes (secondary Milialar), as few or many lesions, and isolated or associated with other clinical findings.

Primary Miliar —  Milia

Primary milia are small, white cysts that commonly appear on the skin’s surface. These keratin-filled bumps, known as milia, often form around the eyes, nose, and cheeks. While harmless, they can be aesthetically bothersome. Dermatological consultation is recommended for safe extraction and prevention of recurrence.

i. Congenital Milialar

Congenital milia occurs in 40% to 50% of newborns, especially the nose, scalp, upper aspect of trunk, and upper extremities, without significant sex difference. Congenital Milialar presents with a few or numerous lesions and tends to resolve spontaneously within weeks to several months. Milialar may be less common and of delayed onset in premature newborns.

ii. Diagnosis

Typical round keratinous contents of Milialar confirms the diagnosis.

iii. Benign Primary Milialar of Children and Adults

Benign primary Milialar of children and adults also occurs spontaneously. They favour the cheeks and eyelids, along with the forehead and genitalia. Benign primary Milialar in children and adults tend to be more persistent than congenital lesions.

iv. Multiple Eruptive Milialar (MEM)

The lesions that occur spontaneously in too large a number to be classified as simple benign primary milia of children and adults fall under multiple eruptive Milialar (MEM). These cases have been reported in patients aged 15 to 71 years. The most common sites involved by them are the head, upper trunk, and arms. The duration of ‘‘erupting’’ these lesions is over weeks to months.

v. Treatment

Multiple eruptive Milialar lesions respond to topical Tretinoin/Adapalene applied over 6-8 weeks. Some other types of primary Milialar include Nevus depigmentosus with Milialar and Genodermatosis associated.

Secondary Milialar — Milia

Secondary Milia, also known as Milia, refers to tiny, white cysts that form beneath the skin’s surface. These cysts typically result from skin trauma, such as burns or rashes. While primary milia are often associated with newborns, secondary milia can affect individuals of any age. Proper skincare and treatment are essential for managing and preventing these blemishes.

i. Disease-Associated

Secondary milia represent a localised form of Milialar that may be disease-associated, medication-associated, or caused by trauma. Secondary milia may resolve spontaneously but tend to persist. Postbullous (particularly subepidermal) milia are the classic disease associated. EB and Porphyria cutanea tarda are typical examples. Other diseases reported with secondary milia include bullous pemphigoid, herpes zoster, contact dermatitis, bullous lupus erythematosus, Sweet syndrome, early congenital syphilis, lichen sclerosis, Stevens-Johnson syndrome, staphylococcal scalded skin syndrome, bullous erysipelas, dermatitis herpetiformis, lichen planus, leprosy, leishmaniasis, phototoxic reactions, and bullous amyloidosis.

ii. Medications Associated

Medications associated with secondary milia include benoxaprofen, topical steroids, 5-fluorouracil, cyclosporine, and penicillamine. Milia developing after acitretin or nitrogen mustard treatment in patients with mycosis fungoides may be a result of the underlying disease process rather than the medications.

iii. Traumatic Associated

Traumatic superficial abrasions in children are a common cause of secondary Milialar. Other traumatic causes of secondary milia include second-degree burns, dermabrasion, radiotherapy, chemical peels, skin grafts, and ablative laser therapy. It is unclear whether trauma creates Milialar through epidermal implantation or by providing a stimulus for undifferentiated pilosebaceous cells to proliferate. Calcified nodules developing after neonatal heel sticks have been well documented, especially in high-risk neonates after repeated skin.

iv. Causes of Milialar

Milialar can be caused by various factors, such as genetics, dead skin cells not exfoliating properly, using oil-producing makeup products, or due to certain skin conditions.

Treatment Protocols for Milia or Milialar

Unlock smooth, radiant skin with effective treatment protocols for Milia or Milialar. Begin with gentle cleansing, followed by targeted exfoliation to unclog pores. Incorporate retinol for cell turnover and consider professional extraction for stubborn milia. Hydrate and protect your skin for a flawless complexion. Follow these steps for skincare success.

i. Apply a Gentle Scrub on Your Face

You need to gently scrub your face with some cleanser like Glycolic acid, Lactic acid or Salicylic acid to gently peel off the Milialar cysts.

ii. Topical Retinoids

Topical retinoids — a derivative of vitamin A — and Adapelene (Adapco Gel) play a significant role in clearing the Milialar lesions of the face, especially in multiple eruptive Milialar is a type of primary lesions but can be used in either. Consult a dermatologist before applying topical agents.

iii. Laser / Electrocautary

Laser & electrocautery are good options for multiple Milialar. These procedures are used to break Milialar (burning) and boost collagen deposition at the same site. Laser removal is used to destroy Milialar cysts, let your dermatologist decide the procedure for removing Milialar lesions on your skin.

iv. Cryotherapy

Liquid nitrogen freezes the cysts.

v. Extraction

The most effective treatment for an individual is simple evacuation, such as by nicking it with a scalpel blade and applying tangential pressure with a comedone extractor or curette.

Home Remedies for Milialar

The use of warm compresses using soft clothes makes Milialar cysts soft. Just peel off them after warm compresses. Be careful, you should avoid squeezing or popping the Milialar cysts by yourself.

Prevention

• Use of sunblock (D-Tox Sunblock)
• Apply topical Vitamin C to prevent hyperpigmentation and Milialar cyst formation.
• Wash your face regularly with a face wash and clean it gently.
• Keep yourself well hydrated to prevent skin dryness.
• Use oil-free makeup products or try to limit the use of makeup.
• Avoid the use of lotion or fancy creams on your face.

Conclusion

Milialar are mostly seen on the face, where they typically appear as small white keratin cysts (1¬2 mm in size) around the eyelids and on the upper cheeks. They are often seen in children but may appear at any age. Occasionally, Milialar may develop as part of healing after a subepidermal blister, e.g. with porphyria cutanea tarda. Milialar cysts can normally be extracted using a sterile needle or disappear by oneself after a few weeks.

Frequently Asked Questions

Q. Are milia the same as pimples?

Ans. No, they’re different. Milia is not related to acne and are usually small, hard bumps filled with keratin, not pus.

Q. Can I squeeze or pop Milialar at home?

Ans. It’s not recommended. Unlike pimples, milia are hard and squeezing can damage the skin. Extraction should be done by a dermatologist to avoid scarring.

Q. Does Milia go away on their own?

Ans. In many cases, yes. Milialar often resolves on their own over weeks to months. However, if they persist or distress you, consider professional removal options.

Q. Can I prevent milia from forming?

Ans. You can reduce the likelihood by using oil-free skincare products and avoiding heavy creams.

Q. Are their home remedies for Milialar?

Ans. Gentle exfoliation, warm compresses, and using non-comedogenic products may help, but it’s always best to consult with a dermatologist for professional advice.

Q. When should I see a dermatologist about Milialar?

Ans. If your Milialar persists, it’s advisable to see a dermatologist for professional guidance and removal options.