Milia

Overview 

Milia are tiny, white bumps that appear on the skin, often in clusters. They are essentially small cysts filled with keratin, a protein found in skin, hair, and nails. Milia are usually harmless and don’t cause any pain or discomfort. They are most common in newborns, but can occur at any age.

Key points:

• Appearance: Small, white or yellowish, dome-shaped bumps.
• Location: Commonly found on the face, especially around the nose, cheeks, and eyelids, but can appear anywhere on the body.
• Cause: Trapped keratin beneath the skin’s surface.
• Treatment: Often resolves on its own within a few weeks or months, but various treatment options are available if needed.
• Other names: Milk spots, oil seeds.

Important to note:

• Milia are not acne, although they can sometimes be confused with whiteheads.
• While usually harmless, milia can sometimes be associated with underlying skin conditions or injuries.

Basic Concept

• In general, Milia are common non-cancerous (benign) skin findings in people of all ages. Moreover, It formed directly from sloughed-off skin (primary milia) small, fluid-fill lesions (cysts) usually found on the faces of infants and adults, while lesions formed indirectly (secondary milia) small cysts found within areas of skin affected by another skin condition.
• It form when skin does not slough off normally but instead remains trapped in a pocket on the surface of the skin. An individual milium form (derived) from a hair follicle (pilosebaceous unit) or from a sweat gland (in other words, eccrine gland). In primary milia in infants, the oil gland (in other words, sebaceous gland) may not fully develope. Secondary milia often develop after injury (trauma) or blistering of the skin, which disrupts and clogs the tubes (glandular ducts) leading to the skin surface. Secondary milia can also develop on the sun-damaged skin of middle-aged and older people.

If you have any concerns about milia or any other skin condition, it’s always best to consult Homeopathic adermatologist for proper diagnosis and advice.

Epidemiology

There is no any specific studies on the Indian epidemiology of milia. However, milia is a common condition worldwide, affecting people of all ages and ethnicities. There is no reason to believe that its prevalence would be significantly different in India.

Causes 

• Heavy Skin Care Products

No doubt the most common reason it form is from smothering your skin with heavy skin care products or hair care items. Comedogenic creams and lotions may prevent the sloughing of dead epidermal skin cells. Hidden problem products include make-up removers not labeled oil-free or non-comedogenic, hair spray, hair mousse and gel, heavy sunscreens and some moisturizers. The eyelids are very thin and more likely to experience problems with milia due to cosmetics. Re-evaluate your eye make-up and eyelid make-up remover if you are finding this to be a concern.

• Prolonged History Of Sun Damage

The formation of It can also be due to cumulative sun exposure. Aging skin forms a thicker epidermis that may make it far more difficult for skin cells to find their way out of the glands. And thicker skin also makes for more road blocks in the pathway to exfoliation.

• Porphyria Cutanea Tarda

It can also be associated with certain skin diseases, particularly blistering disorders such as Porphyria Cutanea Tarda. Fortunately, there are other symptoms associated with these blistering diseases. Blisters, for one and increased hair on the face and backs of hands and knuckles, for another. PCT is an unusual disorder. If you have It, don’t initially jump to the conclusion you have a blistering condition.

• Genetics

Sometimes we just inherit certain undesirable skin tendencies.

Types  

• Primary: Occurring spontaneously, often in newborns.
• Secondary: Developing after skin trauma or certain skin conditions.
• Milia en plaque: Larger, plaque-like lesions with multiple milia.
• Multiple eruptive: Sudden onset of numerous milia. [1]

Risk factors 

• Age: They are most common in newborns but can occur at any age.
• Skin trauma: Burns, blistering disorders, and other skin injuries can increase the risk of secondary milia.
• Skin conditions: Certain conditions like epidermolysis bullosa, porphyria cutanea tarda, and pseudoxanthoma elasticum are associated with milia.
• Genetic predisposition: Some individuals may have a genetic tendency to develop this.
• Certain medications: Some topical corticosteroids and other medications can contribute to its formation. [2]

Pathogenesis of Milia

• Keratin retention: They are small, superficial epidermal cysts filled with keratin, a protein produced by skin cells. They arise due to the entrapment of keratin within small pockets in the skin.
• Primary milia: In primary milia, seen mostly in newborns, keratin retention occurs within the developing pilosebaceous units (hair follicles and associated sebaceous glands).
• Secondary milia: In secondary milia, which can occur at any age, keratin retention often happens due to damage to the skin’s surface or underlying structures. This damage can be caused by trauma, inflammation, or certain skin conditions.
• Milia en plaque and multiple eruptive milia: The exact pathogenesis of these less common forms of milia is not fully understood, but they are also thought to involve abnormal keratinization and retention within the skin. [3]

Pathophysiology 

It is tiny epidermoid cysts. The cysts may be derived from the pilosebaceous follicle. Primary milia arise on facial skin bearing vellus hair follicles. Secondary milia result from damage to the pilosebaceous unit.

Race

No racial predilection is recognized.

Sex

Sexual prevalence is equal for primary and secondary milia. Eruptive milia and milia en plaque occur more frequently in women.

Age

It occur in persons of all ages but are typically found in infant

Clinical Features of Milia

• Appearance: Small (1-2 mm), firm, white or yellowish papules with a smooth surface.
• Distribution: Most commonly found on the face, especially around the eyelids, cheeks, and forehead. They can also occur on other body parts, such as the trunk, genitalia, and extremities.
• Symptoms: It is typically asymptomatic and do not cause pain, itching, or discomfort.
• Number: It can be solitary or multiple.
• Variations:
  
  • Neonatal milia: Common in newborns, often appearing on the nose, cheeks, and chin. They usually disappear within a few weeks.
  • Milia en plaque: Larger, plaque-like lesions with multiple milia, usually found on the head and neck.
  • Multiple eruptive milia: Sudden onset of numerous milia, usually on the face and upper trunk. [4]

Signs and Symptoms of Milia

They are asymptomatic. In children and adults, they usually arise around the eye. Eruptive milia, as the name suggests, have a rapid onset, often within a few weeks.

Physical

• Skin lesions

  • They are superficial, uniform, pearly white to yellowish, domed lesions measuring 1-2 mm in diameter.
  • In milia en plaque, multiple milia arise on an erythematous plaque.

• Skin distribution

  • Primary milia, in term infants, occur on the face, especially the nose. They also may found on the mucosa (Epstein pearls) and palate (Bohn nodules).
  • Primary milia in older children and adults develop on the face, particularly around the eyes.
  • They  have observed to occur in a transverse, linear distribution along the nasal groove in some children.
  • Secondary milia are found anywhere on the body at the sites affected by the predisposing condition.
  • Eruptive milia occur on the head, neck, and upper body.
  • Milia en plaque manifests as distinct plaques on the head and neck. Plaques have describe in the postauricular area, unilaterally or bilaterally, the cheeks, the submandibular plaques, and on the pinna.

Clinical Examination 

• Visual inspection: Careful examination of the skin with good lighting is essential to identify the characteristic white or yellowish papules of milia. The distribution, number, and size of the lesions should be noted.
• Palpation: Gently palpating the lesions can help confirm their firm, smooth texture and superficial location.
• Dermoscopy: In some cases, dermoscopy (examination with a handheld magnifying device) may be used to visualize the internal structure of the milia and differentiate them from other skin conditions.
• Patient history: A detailed history should be taken, including the age of onset, duration, and any associated symptoms or underlying skin conditions.
• Differential diagnosis: It should be differentiated from other skin conditions with similar appearances, such as closed comedones, sebaceous hyperplasia, syringoma, and trichoepithelioma. [5]

Diagnosis 

• Visual Inspection: It is typically diagnosed based on their characteristic appearance as small, white or yellowish, firm papules. They are often found in clusters on the face, especially around the eyelids.
• Dermoscopy (optional): In some cases, dermoscopy can be used to confirm the diagnosis. It appears as round, white structures with a smooth surface under dermoscopy.
• Histopathology (rarely needed): A skin biopsy followed by histopathological examination is rarely necessary to diagnose milia. If performed, it would reveal a small, keratin-filled cyst within the epidermis. [6]

Differential Diagnosis

• Closed comedones (whiteheads): These are also small, white papules, but they are often slightly larger than milia and may have a central pore. They are more common in areas with active sebaceous glands, such as the forehead, nose, and chin.
• Sebaceous hyperplasia: These are yellowish papules that may resemble milia, but they are usually larger and have a central umbilication. They are more common in older individuals and are often found on the forehead and cheeks.
• Syringoma: These are small, skin-colored or yellowish papules that often occur in clusters around the eyes. They are typically softer than milia and may have a sweat gland origin.
• Trichoepithelioma: These are small, firm, skin-colored or pink papules that often occur on the face. They may resemble milia, but they are usually larger and may have a hair follicle origin.
• Epidermal cysts: These are larger, often mobile, subcutaneous cysts that may contain keratinous material. They are typically found on the scalp, face, neck, or trunk.
• Xanthelasma palpebrarum: These are yellowish plaques that occur on the eyelids and are associated with elevated cholesterol levels. [7]

Complications 

• Erythema (redness): The area around the milia may become red and swollen.
• Pain or tenderness: The milia may become painful to the touch.
• Pus formation: If the milia becomes infected, pus may accumulate within the lesion. [1]

Investigations 

• Dermoscopy: This non-invasive technique allows for closer examination of it, under magnification. It can help confirm the diagnosis and differentiate milia from other similar-appearing lesions.
• Skin biopsy: A skin biopsy is rarely needed for the diagnosis of it. However, it may be performed if there is any doubt about the diagnosis or if the lesions are atypical. Histopathological examination of the biopsy specimen will reveal a small, keratin-filled cyst within the epidermis.
• Laboratory tests: Blood tests or other laboratory investigations are not typically required for the diagnosis of it. However, if an underlying skin condition is suspected, such as a blistering disorder or genodermatosis, relevant tests may be ordered. [4]

Treatment 

Medical Care

• No topical or systemic medications are effective on primary and secondary milia.

Surgical Care

• It can safely left alone, but if the patient requests treatment, then incision with a cutting-edge needle and manual expression of the contents are effective. This can perform without local anesthetic.
• Milia en plaque has treated effectively with electrodesiccation, carbon dioxide laser, dermabrasion, and cryosurgery.

Homoeopathic Treatment
Thuja is a very well proven remedy for milia. To use under the supervision of a doctor.
“HOMOEOPATHY FOR TOTAL SAFE AND NATURAL WAY OF CURE WITHOUT SIDE EFFECT"

Prevention

• Gentle Skin Care: Avoid harsh scrubbing or using abrasive products that can damage the skin’s surface.
• Sun Protection: Protect the skin from excessive sun exposure, which can contribute to skin damage and milia formation. Use a broad-spectrum sunscreen with SPF 30 or higher daily.
• Avoid Heavy Creams and Ointments: These can clog pores and trap keratin, leading to milia. Opt for lightweight, non-comedogenic moisturizers.
• Proper Wound Care: If you have any skin injuries, ensure proper wound care to promote healing and minimize the risk of secondary milia. [2]

Homeopathic Treatment

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

Which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do? 

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. Now a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improve with homeopathic medicines.

Homeopathic Medicines for Milia: 

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).

Medicines:

Calcarea iodata

• In general, Calcarea iodata is considered a specific remedy for it.
• It is prescribed to flabby children subject to cold.
• Secretions inclined to be profuse also yellow.
• Besides this, Scrofulous children with enlarged glands.
• Calcarea iodata is more suitable to those children suffering from adenoids.

Staphysagria

• Staphysagria is another excellent medicine for this.
• The skin is very sensitive touch which may bring convulsions.
• The patient experiences itching, by scratching itch may changes location.

Thuja

• Thuja is best medicines for it.
• Especially suited to hydrogenous constitution of Grauvogl, which is related to sycosis as effect is to cause.
• Acts well in lymphatic temperament, in very fleshy persons, dark complexion, black hair, unhealthy skin.
• Thuja bears the same relation to the sycosis of Hahnemann—fig warts, condylomata also wart-like excrescenses upon mucous and cutaneous surfaces.
• Ailments from bad effects of vaccination, from either suppressed or maltreated gonorrhea.
• Skin is Looks dirty; brown or brownish-white spots here and there; warts, large, seedy, pedunculated.
• Eruptions only on covered parts, burn after scratching.
• Nails are Deformed, brittle
• Sweat Only on uncovered parts; or all over except the head, when he sleeps, stops when he wakes, profuse, sour smelling, fetid, at night.
• Perspiration, smelling like honey, on the genitals
• Aggravation: At night; from heat of bed; at 3 a.m. and 3 p.m.; from cold, damp air; narcotics.

Causticum

• Causticum is good medicine for it.
• It is adapted to persons with dark hair and rigid fibre, weakly, psoric, with excessively yellow, sallow complexion, subject to affections of respiratory and urinary tracts.
• Children with dark hair and eyes, delicate, sensitive; skin prone to intertrigo during dentition or convulsions with eruption of teeth.
• Patient improves for a time, then comes to a “stand still”.
• Cicatrices, especially burns, scalds, freshen up, become sore again,old injuries re-open; patients say “they never have been well since that burn.”
• Also, medicines for Warts: Large, jagged, often pedunculated; bleeding easily; exuding moisture; small, all over the body; on eyelids, face; on the nose.
• Rawness or soreness of skin.
• It affects the right side most prominently.
• Cannot cover too warmly, but warmth does not aggravation.
• Aggravation: In clear, fine weather; coming from the air into a warm room, cold air, especially draft of cold air, on becoming cold; from getting wet or bathing.
• Amelioration: In damp, wet weather; warm air.

Antium crud

• Generally, Antium curd is the good medicine for unwanted eruption on body.
• For children and young people inclined to grow fat, for the extremes of life.
• Old people with morning diarrhea, suddenly become constipated, or alternate diarrhea and constipation; pulse hard and rapid.
• Sensitive to the cold, worse condition especially after taking cold.
• Longing for acids and pickles.
• Cannot bear the heat of sun; worse from over-exertion in the sun aggravation from over-heating near the fire; exhausted in warm weather, ailments from sunburn.
• Aversion to cold bathing; child cries when washed or bathed with cold water, cold bathing causes violent headache, causes suppressed menses, colds from swimming or falling into the water.
• Disposition to abnormal growths of the skin.
• Fingernails do not grow rapidly; crushed nails grow in splits like warts with horny spots.
• Aggravation: After eating; cold baths, acids or sour wine; after heat of sun or fire; extremes of cold, or heat.
• Amelioration: In the open air, during rest, after a warm bath.

Diet & Regimen

For milia

• Diet:

  • Vitamin A: Important for skin cell turnover. Include:
    • Orange/yellow fruits and vegetables (carrots, sweet potatoes)
    • Leafy greens (spinach, kale)
    • Eggs
  • Healthy fats: Essential for skin health. Good sources:
    • Avocados
    • Nuts and seeds
    • Olive oil
  • Hydration: Drink plenty of water to keep skin hydrated.
  • Limit: Processed foods, sugary drinks, and excessive dairy, which may contribute to skin issues for some people.

  Regimen:

  • Gentle cleansing: Wash your face twice daily with a mild cleanser.
  • Exfoliation: Use a gentle exfoliant 2-3 times a week to remove dead skin cells.
  • Sun protection: Always wear sunscreen with SPF 30 or higher.
  • Avoid harsh products: Skip harsh scrubs or products that irritate your skin.
  • Don’t pick or squeeze: This can cause scarring.
  • Consider: Retinoids (consult a dermatologist first).

Do’s and Don’ts 

Milia do’s and don’ts 

Do’s:

• Do practice good skincare: Gently cleanse and moisturize your face twice daily with products suitable for your skin type.
• Do exfoliate regularly: Use a gentle exfoliator 1-2 times a week to remove dead skin cells and prevent clogged pores.
• Do protect your skin from the sun: Use a broad-spectrum sunscreen with SPF 30 or higher daily, even on cloudy days.
• Do consult a dermatologist: If milia are bothersome or persistent, seek professional help for removal options.
• Do be patient: Milia often resolve on their own within a few weeks or months, especially in newborns.

Don’ts:

• Don’t pick or squeeze milia: This can damage the skin, lead to scarring, and increase the risk of infection.
• Don’t use harsh scrubs or abrasive products: These can irritate the skin and worsen milia.
• Don’t use heavy creams or ointments: These can clog pores and trap keratin, leading to more milia.
• Don’t self-treat with home remedies: While some home remedies may seem tempting, they are often ineffective and can potentially harm your skin.

Terminology

• Keratin: A protein that makes up the outer layer of the skin.
• Epidermis: The outermost layer of the skin.
• Cyst: A closed sac-like structure that can be filled with fluid, air, or other material. In the case of milia, they are filled with keratin.
• Primary milia: Milia that occur spontaneously, often in newborns.
• Secondary milia: Milia that develop as a result of skin trauma or certain skin conditions.
• Milia en plaque: Larger, plaque-like lesions with multiple milia.
• Multiple eruptive milia: Sudden onset of numerous milia.
• Comedones: Plugged pores, also known as blackheads or whiteheads.
• Dermoscopy: A non-invasive technique that uses a handheld device to examine the skin in more detail.
• Biopsy: A procedure in which a small sample of tissue is removed for examination under a microscope.

Homoeopathic Terms

• Similia Similibus Curentur: This Latin phrase is the foundation of homoeopathy, meaning "like cures like." It means that a substance that can cause symptoms in a healthy person can cure similar symptoms in a sick person when given in a highly diluted form.
• Remedies: Homoeopathic medicines are called remedies. They are derived from natural substances like plants, minerals, or animals and are highly diluted.
• Potency: The number of times a remedy has been diluted and succussed (shaken vigorously) is its potency. Higher potencies are considered more powerful.
• Miasm: A miasm is a predisposition to certain types of diseases or illnesses, believed to be inherited and underlying chronic conditions. Homoeopaths consider miasms when selecting remedies.
• Constitutional Remedy: This is a single remedy that matches the overall physical and mental characteristics of a person, aimed at treating the root cause of their health issues.
• Aggravation: A temporary worsening of symptoms after taking a remedy, often considered a positive sign of the body’s healing response.
• Proving: The process of testing a remedy on healthy volunteers to determine its symptom profile and potential uses.
• Repertory: A book that lists symptoms and the remedies associated with them, used by homoeopaths to find suitable remedies for their patients.

Specific Remedies for Milia (Indicative and not exhaustive):

• Calcarea Carbonica: For milia in infants or individuals with a tendency for slow development and cold extremities.
• Thuja Occidentalis: Often used for milia associated with vaccination or when there are warty growths.
• Hepar Sulphuris Calcareum: Considered for milia that are sensitive to touch and easily inflamed.
• Silicea: For milia that are persistent and slow to heal.

References

1. Bolognia JL, Schaffer JV, Cerroni L. Dermatology, 4th Edition. Elsevier; 2018.
2. Habif TP. Clinical Dermatology: A Color Guide to Diagnosis and Therapy, 7th Edition. Elsevier; 2021.
3. Wolff K, Johnson RA, Saavedra AP. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology, 9th Edition. McGraw-Hill Education / Medical; 2021.
4. James WD, Berger TG, Elston DM. Andrews’ Diseases of the Skin: Clinical Dermatology, 13th Edition. Elsevier; 2020.
5. Leung AKC, Barankin B. Common Skin Conditions in Infants, Children, and Adolescents, 2nd Edition. Springer; 2021.
6. Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K. Fitzpatrick’s Dermatology in General Medicine, 9th Edition. McGraw Hill Professional; 2019.
7. Griffiths C, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology, 10th Edition. Wiley Blackwell; 2020.

Also Search As

People can search for homeopathic articles on milia using a few different methods:

Homeopathic Libraries:

• Visit physical or online libraries: Many homeopathic libraries offer access to books, journals, and other resources on homeopathic treatments for various conditions.

Online Search Engines:

• Use specific keywords: Search for terms like "homeopathic remedies for milia," or "homeopathic treatment for milia."
• Include reputable sources: Add phrases like "homeopathic journal," "homeopathic research," or "homeopathic case study" to your search to find credible information.
• Check homeopathic websites: Explore websites of homeopathic organizations, clinics, or practitioners, as they often publish articles or case studies on various conditions, including milia.

Homeopathic Repertories:

• Refer to repertories: These are books that list symptoms and their corresponding homeopathic remedies. Look for the section on skin conditions and search for milia-related symptoms.  
  
   
• Consult a homeopath: They can use repertories and their expertise to identify the most suitable remedies for your specific case.

Homeopathic Forums and Communities:

• Participate in online forums or groups: Connect with other individuals interested in homeopathy and discuss their experiences with milia treatment. However, always consult a qualified practitioner before self-treating.

There are several ways to search for information about milia:

Online Search Engines:

• Use search terms like "milia," "white bumps on skin," "milk spots," or "keratin cysts."
• Include specific keywords like "milia causes," "milia treatment," or "milia home remedies" for targeted results.
• Explore reputable websites like medical organizations, dermatology clinics, and health information websites.

Medical Databases and Journals:

• Search databases like PubMed, Google Scholar, or ScienceDirect for scientific articles and research studies on milia.
• Look for articles published in reputable dermatology journals.

Medical Textbooks and Reference Books:

• Consult dermatology textbooks or reference books available in libraries or online.
• Look for sections on milia or related skin conditions.

Online Forums and Communities:

• Join online forums or communities dedicated to skin health or dermatology.
• Ask questions or share experiences with other members who may have dealt with milia.

Consult a Dermatologist:

• The most reliable way to get information about milia is to consult a dermatologist.
• They can diagnose milia, discuss treatment options, and provide personalized advice.