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A milium is a small bump located under the skin. Most patients have more than one milium; they are referred to as milia when there is more than one present. These small, pearly-white cysts are harmless. They contain a type of skin protein called keratin and are caused by the accumulation of dead skin cells.
Patients will often see a milium on the face; however, they may appear anywhere. When the bumps appear on the roof of the mouth, they are referred to as Epstein pearls. Infants are especially susceptible to developing the bumps, usually on the chin, cheeks, and nose.
This skin condition is not a cause for concern and it is usually not treated. The skin typically clears up by itself; however, concerned parents or patients may explore treatment options if a milium persists after three months. Those who have widespread bumps may use a topical retinoid, which may help clear up the skin. When a milium appears inflamed, the doctor may prescribe a tetracycline antibiotic.
Other skin treatments can include chemical peels, during which a dermatologist will apply a chemical to the skin to remove top layers of skin cells. Dermabrasion may also be helpful, which utilizes an abrasive tool to resurface the skin. An alternative to dermabrasion is laser ablation, which uses a laser to reduce or remove the milia.
In some cases, the doctor may use a sterilized needle to poke the lesion and then squeeze it. Another option to remove a milium is cryotherapy, which freezes the skin growth. Patients may also discuss curettage with a dermatologist. In this procedure, a tool is used to scrape off the milium and then heat is applied to cauterize the area. A local anesthetic is used so that the patient does not feel pain during the procedure.
There are different classifications of milia, such as primary milia in children and adults, which often clears up in a few weeks. It may appear as a row of bumps along the nose, or around the eyelids or genitalia. Neonatal milia is common in newborn infants and usually disappears on its own within several weeks. Juvenile milia, which may be present at birth or later in life, is often associated with another medical condition, such as Gardner syndrome or Bazex-Dupre-Christol syndrome.
Adults may develop a milium that is associated with the use of certain topical drugs, such as corticosteroids or hydroquinone. They may also acquire the condition as a result of trauma to the skin. The bumps may develop as the skin heals. Milia en plaque are inflamed, may be associated with other skin conditions, and often affect middle-aged women. The last classification of this skin condition is multiple eruptive milia, which occurs as a scattering of the bumps that may affect the trunk, face, or upper arms.