MILIA & SKIN CYST

The most common types of skin cysts include:

• Epidermal cysts, also known as sebaceous cysts.
• Pilar cysts, also called trichilemmal cysts.
• Vellus hair cysts.
• Milia.

Epidermal Cysts

• Origin: These cysts develop from the wall of hair follicles in the skin, often triggered by trauma or persistent blockage of pores (comedones).
• Appearance: They typically appear as skin-colored nodules with a central punctum (opening). Gentle pressure can sometimes cause them to release a smelly, sebum-like substance. Sizes can vary from a few millimeters to several centimeters, and they may remain stable or gradually grow over time.
• Complications: Secondary infections can lead to sudden increases in size, pain, inflammation, and pus discharge from the cyst. Diagnosis is usually made through clinical examination, occasionally requiring a skin biopsy for confirmation.
• Treatment Approach: Non-inflamed or non-infected cysts may not require treatment unless desired by the patient. However, excision is recommended for rapidly growing cysts or those causing symptoms such as pain, inflammation, or recurrent infections.
• Surgical Techniques: Excision methods like punch excision and minimal incision are often used for non-inflamed cysts. These techniques involve making a small incision at the most prominent part of the cyst and removing it along with its wall. For infected cysts, drainage of pus and antibiotic therapy may be necessary before surgical excision.

Pilar (trichilemmal) cysts

Pilar (trichilemmal) cysts are similar in appearance to epidermal cysts but originate from a different part of the hair follicle. They are often found on the scalp and can be multiple in familial cases. Unlike epidermal cysts, they are less likely to rupture and do not have a central punctum. Surgical excision of pilar cysts is typically easier compared to epidermal cysts.

Vellus hair cysts

Vellus hair cysts appear suddenly as small, dome-shaped papules with a greenish hue due to the presence of hair in the cyst's content. They are typically asymptomatic and may resolve spontaneously. However, if there are many cysts or for cosmetic reasons, treatment may be necessary. Treatment options for vellus hair cysts include incision and extraction, intralesional radiofrequency ablation (RFA), or CO2 laser ablation.

Milia

Milia are small white bumps that often appear in children but can also develop at any age. They are generally harmless and typically do not need treatment. However, if there are cosmetic concerns or multiple lesions in a clustered area, treatment may be sought. Unfortunately, there is no known effective method to prevent milia from forming.

CAUSES

Milia are small keratin cysts that form when skin flakes become trapped just beneath the surface of the skin, often near pilosebaceous or sweat gland ducts. They can be categorized into two types based on their onset:

Primary: These typically develop in newborns but can also appear at any age.

Secondary: Occur due to injuries at the junction of the upper layer (epidermis) and deeper layer (dermis) of the skin, such as second-degree burns, blistering skin diseases, skin abrasions, or during the healing process.

Colloid milium is another type of milia, often associated with chronic sun exposure (UV rays) and autoimmune disorders.

SYMPTOMS

Milia lesions are small, typically 1-2 mm in size, and appear as white-colored, pearl-like bumps. They have a firm and smooth surface and commonly develop on the face. These bumps may appear individually or in clusters, either spaced apart or close together.

Milia in kids

Milia are frequently observed on a baby's nose, chin, or cheeks, and occasionally on the upper trunk or limbs. In children, these milia lesions typically resolve on their own without requiring treatment, often clearing up within weeks or months.

Milia in adults

Milia in adults are commonly found on the face, with the cheeks, areas around the eyes, nose, and chin being the most frequently affected. Occasionally, milia may also appear on the sides of the forehead.

Colloid milium, characterized by clusters of milia with a yellowish-white appearance, is most commonly seen behind the ear area.

How dermatologist Diagnose milia?

Milia are typically diagnosed by dermatologists through clinical examination alone. In some cases, a woods lamp examination may be conducted, and occasionally a skin biopsy is needed, especially for colloid milium.

Treatment options for Milia Removal?

Milia are generally harmless and typically do not necessitate active treatment. Cosmetic concerns are the primary motivation for seeking treatment for milia. There are no creams or oral medications that can effectively clear milia. Topical retinoid creams may have limited success, but their potential for causing irritation and dryness makes them less effective for treating milia. Therefore, the most effective approach is to remove milia for the best outcome.

• Needle Extirpation: This is the most commonly performed treatment for milia removal. It involves making a small incision on the roof of the cyst and then using fingers or a safety pin to extract the contents of the cyst.
• Radiofrequency Ablation: This treatment involves making an incision with an RFA machine to remove the milia.
• CO2 Laser Treatment for Milia: In this procedure, an incision is made using a CO2 laser, which is particularly useful when there are numerous lesions clustered closely together. Often, there is no need to manually extract the contents as they tend to fall out on their own.

Prevention of milia

• Regular exfoliation treatments such as hydrafacial or microdermabrasion can be beneficial.
• Using a salicylic acid face wash to manage oily skin and applying topical retinoid creams 2-3 times a week may also provide some help.