Dermatology
Case Five
A 30-year-old male presents to your clinic and asks, “Doctor, this white bump on my cheek came up a few months ago and won’t go away. What is it?”
Milia
Diagnosis
Milia: tiny epidermoid cysts
- 1-2 mm white to yellow subepidermal papules
- They are fixed and persistent
Occur in individuals of all ages
- Children and adults commonly develop milia, especially on the cheeks, eyelids, forehead, and genitalia
- 40-50% of infants will have milia, which usually resolve during the 1st four weeks of life
Can be considered primary, appearing spontaneously, or secondary, resulting from trauma, a skin disease, or medication
Milia treatment
- What will you tell the patient? a) It can be easily extracted without scarring b) Just wait for it to go away on its own; we see this in newborns all the time c) Pop it like a pimple d) The only treatment is surgical and the scar would be worse than the milia
Milia treatment Discussion
- What will you tell the patient? a) It can be easily extracted without scarring b) Just wait for it to go away on its own; we see this in newborns all the time (Milia in newborns tend to resolve within weeks. Milia in adults tend to persist) c) Pop it like a pimple (Not effective in treating milia) d) The only treatment is surgical and the scar would be worse than the milia (Not true. Milia are easily extracted without causing a scar)
Milia Extraction Procedure
-
Groove the surface with an 11 blade or an 18 gauge needle, then gently express the entire cyst, lining and contents.
-
Dress with a dab of petrolatum.
Pediatrics
- White globules on the chin, cheeks, and forehead
- Resolves within 1-2 weeks
- No treatment