Milia Treatment | IC Clinic Ueno

✨Introduction

Have you ever looked in the mirror and noticed small white bumps around your eyes or on your cheeks, and felt concerned❓

In many cases, those white bumps may be a benign skin condition called milia (milium cysts)💡

🔍What Are Milia?

📖Definition

Milia are small, white to yellowish-white dome-shaped papules approximately 1–2 mm in diameter that form near the surface of the skin.

They are medically known as “milia” and their name is said to derive from their resemblance to millet seeds🌾

✨Characteristics of Milia

👀 Appearance

• 📏 Small size, approximately 1–2 mm in diameter
• ⚪ White to yellowish-white in color
• 🔘 Dome-shaped, slightly raised
• ✨ Smooth surface with a slight sheen
• 💎 Firm to the touch

🩺 Symptoms

• 😊 No pain or itching
• 🚫 Do not become inflamed
• 🚫 Do not become infected or filled with pus
• 🚫 Not contagious

📍 Common locations

• 👁️ Around the eyes (particularly the eyelids and outer corners)
• 😊 Cheeks, forehead, and around the nose
• 🗣️ Chin and around the mouth
• 🤚 Rarely, the hands, feet, or genital area

💡Symptoms and Appearance of Milia

🎯Typical Symptoms

The most characteristic feature of milia is the appearance of small white bumps on the skin✨

👀 Visual characteristics

• 📌 Ranging from pinpoint size up to approximately 2 mm
• 💎 Pearl-like, lustrous white color
• 🟡 May occasionally appear slightly yellowish
• ⬆️ Slightly raised above the skin surface
• 🔲 Well-defined borders

✋ Tactile characteristics

• 🪨 Feels like a firm, hard nodule
• 📍 Does not move under the skin
• 😌 No pain when pressed

📈Progression

Milia generally:

• 🐌 May slowly increase in size
• ➕ May increase in number
• ⚠️ Rarely resolve on their own, particularly in adults
• 📊 Do not change rapidly
• ✅ Do not become malignant

🔄Distinguishing Milia from Similar Conditions

⚪ Closed comedones (whiteheads)

• 📏 Tend to be slightly larger than milia
• 🔴 Can become inflamed and red
• 💧 Caused by clogged sebum

💧 Syringoma

• ➖ Flatter and more spread out than milia
• 🟤 Skin-colored
• 💦 Caused by proliferation of sweat gland ducts

🟡 Sebaceous hyperplasia

• ⭕ Often has a central depression
• 📐 Larger than milia
• 🟨 More distinctly yellowish

💧 Molluscum contagiosum (water warts)

• ⭕ Has a central dimple
• 🦠 Contagious
• 👶 Occurs mainly in children

🧬Causes and Mechanisms of Milia

⚙️Basic Mechanism of Formation

Milia form when keratin (the protein that makes up skin cells) is not properly shed and instead accumulates within the skin💡

1. 🚫 Blockage of hair follicles or sweat ducts: The pore or sweat duct opening becomes blocked for some reason.
2. 📦 Keratin accumulation: Old skin cells that should normally shed become trapped within the skin.
3. 🎒 Cyst formation: The accumulated keratin forms a sac-like structure (cyst).
4. ⚪ Milium formation: The cyst appears as a white bump on the skin surface.

🎯Contributing Factors

🔄 Disrupted skin cell turnover

• ⚠️ Impaired normal skin cell renewal
• ⏳ Age-related decline in skin metabolism
• ⚖️ Hormonal changes

💥 External irritants

• 🧼 Overly aggressive cleansing or skincare routines
• 💄 Pore-clogging cosmetics
• ☀️ UV-related skin damage
• ✋ Friction and physical irritation

🧬 Constitutional factors

• 🏜️ Dry skin
• 🩹 Skin conditions such as atopic dermatitis
• 👪 Genetic predisposition
• 💧 Abnormal sebum production

🏃 Lifestyle factors

• 😴 Irregular sleep patterns
• 🍔 Poor dietary balance
• 😰 Stress
• 🚬 Smoking

👶Age-Related Differences

👶 Newborns and infants

• 📊 Occur in approximately 40–50% of newborns
• 🍼 Related to hormonal influences and underdeveloped sweat glands
• ✨ Most resolve on their own within about one month

🧒 Children

• 📉 Relatively uncommon
• 🌟 When they do appear, they often resolve spontaneously

👩 Adults

• 📈 Most common age group affected
• ⚠️ Rarely resolve on their own once they appear
• 👩 Slightly more prevalent in women

👴 Older adults

• ⏳ More likely to develop alongside natural skin aging
• ➕ Multiple milia are common
• 🔄 Higher rate of recurrence after treatment

📂Types and Classification of Milia

🔀Primary Milia and Secondary Milia

Milia are broadly classified into two main types based on their cause📋

1️⃣ Primary Milia

Definition Milia that develop spontaneously without a specific underlying cause, accounting for approximately 80% of all cases✨

✨ Characteristics

• ❓ No identifiable external cause
• 👶 May involve abnormalities in skin formation during fetal development
• 🧬 Genetic predisposition may play a role
• 👧 More common in children and younger women

👶 Neonatal primary milia

• 🍼 Onset from birth to a few weeks of age
• 👃 Multiple lesions commonly appear on the nose and face
• 👦👧 Occurs regardless of sex
• ✨ Typically resolves spontaneously within about one month

👨 Primary milia in children and adults

• 🌱 Often develops after puberty
• 👁️ Favors the area around the eyes and cheeks
• ⚠️ Rarely resolves on its own
• 💊 Treatment is often required

2️⃣ Secondary Milia

Definition Milia that develop following skin injury or disease, accounting for approximately 20% of all cases🩹

🔥 Post-traumatic

• 🔥 Burns
• 🩹 Abrasions or lacerations
• ✂️ Post-surgical scarring
• 💍 Trauma from piercings or similar procedures

🩺 Following skin disease

• 🫧 Blistering conditions (e.g., pemphigus)
• 🩹 Severe atopic dermatitis
• 🔴 Chronic eczema
• ✨ During the healing process of dermatitis

⚕️ Following medical procedures

• ✨ After laser treatment
• 🧪 After Chemical Peeling
• 🩹 After skin grafting
• ☢️ After radiation therapy

🔬Diagnosis of Milia

📋Basic Diagnostic Process

Milia are primarily diagnosed through visual inspection👨‍⚕️

An experienced dermatologist can typically make an accurate diagnosis based on appearance alone in most cases✨

📝 Medical History

⏰ Onset and progression

• 📅 When did you first notice them?
• 📊 Have they changed in size or number?
• 😖 Is there any pain or itching?
• 🩺 Are there any other associated symptoms?

📋 Medical history

• 🩹 Any history of skin conditions
• 🔪 Previous injuries or surgeries
• 🤧 Known allergies
• 💊 Current medications

🆚 Differential Diagnosis

It is important to distinguish milia from conditions that present similarly⚠️

⚪ Closed comedones (whiteheads)

• ✅ Distinguishing features: slightly larger, sebum-based, can become inflamed
• 🔍 Confirmation: contents are sebum-like rather than a white keratin plug

💧 Syringoma

• ✅ Distinguishing features: flatter and more spread out, skin-colored, often multiple
• 🔬 Confirmation: histological examination shows proliferation of sweat gland ducts

🟡 Sebaceous hyperplasia

• ✅ Distinguishing features: central umbilication, more yellow, larger
• 🔍 Confirmation: presence of central dell, nature of contents

💧 Molluscum contagiosum (water warts)

• ✅ Distinguishing features: central dimple, contagious, mainly in children
• 🔬 Confirmation: history of exposure, microscopic examination

💊Treatment Options for Milia

⚖️General Treatment Approach

✅ When treatment may be recommended

• 😟 The patient has cosmetic concerns
• 💄 The milia interfere with makeup application
• 📈 They have grown and become more noticeable
• ➕ Multiple milia are causing a visible cosmetic issue

😌 When watchful waiting is appropriate

• 📏 They are small and not very noticeable
• 😊 The patient is not particularly bothered by them
• 👶 In newborns or infants (where spontaneous resolution is possible)

✨Self-Pay Treatment Options

🔆CO2 Laser (Carbon Dioxide Laser)

Overview A method that uses a CO2 laser to ablate and remove milia⚡

✅ Advantages

• 🎯 Lower recurrence rate (approximately 5–10%)
• 🎚️ Precise depth control
• 🩸 Minimal bleeding
• ✨ Less visible scarring
• ➕ Multiple lesions can be treated in one session

⚠️ Disadvantages

• 💰 Higher cost as a self-pay treatment
• ⬇️ Temporary indentation at the treatment site may occur
• 🟤 Risk of post-inflammatory hyperpigmentation
• ⏱️ Relatively longer downtime

💰 Cost

• 💴 Approximately 5,000–15,000 yen per lesion
• 🏥 Pricing varies by clinic

📊Treatment Outcomes and Prognosis

💉 Extraction (comedone extractor method)

• ✅ Immediate removal rate: approximately 95%
• 🔄 Recurrence rate: approximately 20–30%
• 😊 Patient satisfaction rate: approximately 80%

🔆 CO2 laser

• ✅ Immediate removal rate: approximately 98%
• 🔄 Recurrence rate: approximately 5–10%
• 😊 Patient satisfaction rate: approximately 90%

🎯Selecting the Appropriate Treatment

📌 For a small number of lesions (approximately 1–5)

• 💉 Extraction is typically the first-line option
• 💰 Good cost-effectiveness
• ⏱️ Shorter downtime

📌 For a greater number of lesions (6 or more)

• 🔆 Laser treatment may be considered
• ➕ Multiple lesions can be treated in one session
• 💴 May offer better cost performance over the long term

📌 For recurrent milia

• 🔆 Consider switching to laser treatment
• 🧬 Address underlying constitutional factors
• 🧴 Strengthen preventive skincare measures

🛡️Prevention of Milia

💧Prevention Through Skincare

🧼Proper Cleansing Technique

🧴 Choosing a cleanser

• ✅ Select a cleanser suited to your skin type
• ⚠️ Avoid cleansers with excessively strong cleansing action
• 😊 Opt for low-irritation formulas
• 🧪 Choose products with a pH close to that of skin (mildly acidic)

🚫 Cleansing habits to avoid

• ❌ Scrubbing vigorously
• 🔥 Using very hot water
• 🔄 Cleansing more than necessary during the day
• 🪥 Overuse of facial cleansing brushes
• 💧 Insufficient rinsing

💦Appropriate Moisturizing Care

✨ Why moisturizing matters

• 🛡️ Maintains the skin’s barrier function
• 🔄 Supports normal skin cell turnover
• 💧 Helps regulate excess sebum production
• 🛡️ Protects the skin from external irritants

🧴 Choosing a moisturizer

• ✅ Texture appropriate for your skin type
• 🚫 Non-comedogenic (less likely to clog pores)
• 🌿 Fragrance-free and dye-free
• ⚖️ Balanced oil content

🥗Prevention Through Lifestyle

🍎Improving Nutritional Balance

🥕 Vitamin A

• 🔄 Supports normal skin cell turnover
• 🥬 Food sources: dark-colored vegetables, liver, eel
• 📊 Recommended intake: 900 μg/day for adult men, 700 μg/day for adult women

🌾 B vitamins

• ✨ Support skin metabolism
• 🍚 Food sources: brown rice, pork, fish, legumes
• 🎯 Vitamins B2 and B6 are particularly important

🍊 Vitamin C

• 💪 Supports collagen synthesis
• 🛡️ Antioxidant properties
• 🍋 Food sources: citrus fruits, strawberries, vegetables

🥜 Vitamin E

• 🛡️ Antioxidant properties
• 🩸 Promotes circulation
• 🌰 Food sources: nuts, vegetable oils, fish

🦪 Zinc

• 🩹 Supports skin repair
• 🥩 Food sources: oysters, meat, seeds and nuts

🚫 Foods to limit

• 🍔 Excessively oily or greasy foods
• 🍰 Excessive intake of high-sugar foods
• 🍺 Excessive alcohol consumption
• ☕ Excessive caffeine intake

😴Improving Sleep Quality

💤 The connection between sleep and skin

• 📈 Promotes growth hormone secretion
• 🩹 Supports skin repair and regeneration
• 😌 Helps regulate stress hormones
• 🔄 Supports normal skin cell turnover

✨ Tips for better sleep

• ⏰ Maintain a consistent sleep and wake schedule
• 📱 Limit smartphone use before bedtime
• 🌡️ Keep the bedroom at an appropriate temperature and humidity
• ☕ Avoid caffeine in the evening
• 🛏️ Create a relaxing bedtime environment

☀️UV Protection

🔆 Harmful effects of UV radiation

• ⏳ Accelerates skin aging
• 🔄 Disrupts skin cell turnover
• 🛡️ Weakens the skin barrier
• 🔥 Triggers inflammation

🧴 Choosing a sunscreen

• ✅ SPF 30 or higher, PA+++ or above
• 😊 Low-irritation formulas for sensitive skin
• 💧 Consider water-resistant formulas when needed

🌂 Additional protective measures

• 👒 Wear a hat or use a parasol
• 🕶️ Wear sunglasses
• 👕 Wear long-sleeved clothing
• 🌳 Walk in the shade when possible

❓Frequently Asked Questions (FAQ)

🔰About Milia: The Basics

💊Questions About Treatment

Q4: Is treatment for milia painful?😖

A: The level of discomfort depends on the treatment method💉 With the most common extraction method, there is mild discomfort when the needle creates a small opening in the skin, but most patients find it manageable✨ For those concerned about discomfort, a topical anesthetic cream can be used💊 With laser treatment, local anesthesia is administered, so discomfort during the procedure is generally minimal😊

Q5: Can I wear makeup after treatment?💄

A: With the extraction method, makeup is possible from the day of treatment, but avoid applying it directly over the treated area😊 You can resume your normal makeup routine from the following day✨ With laser treatment, a scab typically forms over the treated area, and makeup should be avoided on that area until the scab falls off naturally (usually within 1–2 weeks)🩹 Concealer or foundation can be used over the surrounding area💄

Q6: How much does treatment cost?💰

A: For insurance-covered extraction, the cost is typically a few hundred yen with a 30% co-payment (this varies with the number of milia)💴 For self-pay laser treatment, the approximate cost is 5,000–15,000 yen per lesion✨ Having multiple lesions treated together may reduce the overall cost📊 Please contact your chosen clinic for detailed pricing📞

Q7: Can milia recur after treatment?🔄

A: Unfortunately, recurrence is possible⚠️ Reported recurrence rates are approximately 20–30% with extraction and approximately 5–10% with laser treatment📊 Contributing factors include incomplete removal, constitutional predisposition, and inadequate skincare💡 Appropriate preventive care can help reduce the risk of recurrence✨

🏠Managing Milia in Daily Life

Q8: Is it safe to remove milia at home?🤔

A: ❌ Please do not attempt to remove milia yourself!

Trying to extract them with a needle or fingernail carries the following risks⚠️

• 🦠 Bacterial infection and suppuration
• 🩹 Damage to surrounding skin
• 🟤 Permanent scarring or post-inflammatory hyperpigmentation
• ⬇️ Pushing the content deeper into the skin
• ❓ Misidentification of another condition

For safe and appropriate treatment, please always seek care from a dermatologist🏥

Q9: Are there skincare products that can cause milia?🧴

A: The following types of products may contribute to the development of milia⚠️

• 💧 Heavy creams or oils with a high oil content
• 🚫 Cosmetics containing comedogenic (pore-clogging) ingredients
• 💥 Strongly irritating cleansers or exfoliants
• 🍶 Toners with a high alcohol content

We recommend choosing products labeled as non-comedogenic✨

Q10: Are there foods that can help prevent milia?🍎

A: No specific foods have been proven to directly prevent milia, but foods rich in nutrients that support skin health are generally recommended🥗

• 🥕 Vitamin A: dark-colored vegetables, liver
• 🌾 B vitamins: brown rice, fish, legumes
• 🍊 Vitamin C: citrus fruits, vegetables
• 🦪 Zinc: oysters, meat
• 🐟 Omega-3 fatty acids: fish, nuts

Maintaining a well-balanced diet is key😊

🤰Special Circumstances

Q11: Can milia be treated during pregnancy or breastfeeding?🤱

A: The extraction method can be performed safely during pregnancy and breastfeeding✅ However, laser treatment and certain topical medications (such as tretinoin) should be avoided⚠️ Please be sure to inform your physician if you are pregnant or breastfeeding🩺 In many cases, it is advisable to begin treatment after delivery and the completion of breastfeeding👶

Q12: I have atopic dermatitis — can I still be treated for milia?🩹

A: Treatment is possible for patients with atopic dermatitis, but the approach may need to be adjusted depending on the condition of your skin and any medications you are currently using💊 It is generally advisable to prioritize managing the dermatitis first, and then proceed with milia treatment once the skin has stabilized✨ Please provide detailed information about your current treatment at the time of consultation📋

📊Treatment Outcomes and Expectations

Q14: Will my skin look normal right after treatment?✨

A: Recovery time varies depending on the treatment method📅

💉 Extraction

• 📅 Day of treatment: mild redness
• ✨ Next day: largely unnoticeable
• 😊 2–3 days: fully normalized

🔆 Laser treatment

• 🩹 Day of treatment to 1 week: scab formation
• ⏱️ 1–2 weeks: scab falls off
• ✨ 1–3 months: redness fully resolves

Q15: Can all milia be removed in a single treatment?🎯

A: This depends on the number and location of the milia📊

• 1️⃣ Few lesions (1–5): can typically be addressed in one session
• ➕ Many lesions (6 or more): treatment is often spread over several sessions
• 👁️ Delicate areas such as around the eyes: treatment proceeds carefully in stages

We will discuss your treatment plan in detail during your consultation🩺

📌Important Considerations and Summary

⚠️Key Points to Keep in Mind When Treating Milia

🚨 Risks of Self-Diagnosis

While milia are relatively straightforward to diagnose, many similar conditions exist⚠️ Inappropriate self-treatment based on an incorrect self-diagnosis can lead to the following risks💥

• 🦠 Confusing milia with contagious conditions such as molluscum contagiosum
• 🚨 Missing a malignant lesion
• ⏰ Delaying appropriate treatment
• 🩹 Bacterial infection and suppuration
• 🟤 Permanent scarring or post-inflammatory hyperpigmentation

We strongly recommend obtaining an accurate diagnosis from a qualified dermatologist🏥

📝Final Summary

Milia are a common skin condition experienced by many people. Let’s review the key points✨

📖 Understanding the Basics

• ✅ Benign skin cysts that pose no health risk
• ⚠️ Rarely resolve on their own, particularly in adults
• 💄 Many people seek treatment for cosmetic reasons

🎯 Appropriate Response

• 🚫 Avoid self-diagnosis and self-treatment
• 👨‍⚕️ An accurate diagnosis by a qualified dermatologist is important
• 🎯 Treatment should be chosen based on individual circumstances

💊 Treatment Options

• 💰 Insurance-covered extraction (lower financial burden)
• 🔆 Self-pay laser treatment (lower recurrence rate)
• 💊 Pharmacological treatment (primarily preventive)

🛡️ Prevention and Care

• 🧴 Consistent and appropriate skincare routine
• 🥗 Improving lifestyle habits
• 🏥 Regular dermatology visits
• ☀️ Thorough UV protection

💭 Mindset

• 😊 Don’t let milia weigh on you — consider treatment if they are a concern
• ⏰ Commit to long-term skin health management
• 👨‍⚕️ Prioritize consultation with a trusted physician

📚References

1. Berk DR, Bayliss SJ. Milia: a review and classification. J Am Acad Dermatol. 2008;59:1050-63.
2. EPSTEIN W, KLIGMAN AM. The pathogenesis of milia and benign tumors of the skin. J Invest Dermatol. 1956;26:1-11.
3. Connelly T. Eruptive milia and rapid response to topical tretinoin. Arch Dermatol. 2008; 144(6):816-817.
4. Nambudiri VE, et al. Milia en plaque of the nose: report of a case and successful treatment with topical tretinoin. Pediatrics. 2014; 133(5):e1373-1376.
5. Multiple milia localized to the vulva. J Dermatol. 1996; 23(6):427-428.
6. Japan Dermatological Association: Dermatology Q&A “Atheroma (Epidermoid Cyst)” https://www.dermatol.or.jp/qa/qa17/q10.html
7. Japanese Journal of Dermatology, various issues: “Clinical studies on milia”
8. Skin Research (Hifu Rinsho), various issues: “Diagnosis and treatment of milia”
9. Journal of the Japanese Society for Aesthetic Dermatology: “Laser treatment of milia”
10. Journal of the Japanese Society of Plastic and Reconstructive Surgery: “Surgical treatment of milia”

⚠️ Disclaimer: This article is intended for general informational purposes only and is not a substitute for individual medical diagnosis or treatment. If you have any concerns about your symptoms, please consult a qualified healthcare professional at a medical institution🏥