Prosak
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Milia (Latin: milium, plural milia) are benign, superficial skin lesions classified as epidermal cysts, formed due to the accumulation of keratin within the epidermis or the openings of hair follicles. Clinically, milia present as small, hard, whitish or yellowish bumps, typically measuring 1 to 3 mm in diameter, distinctly demarcated from surrounding skin. These lesions do not exhibit inflammatory characteristics, are not painful, and do not have an opening on the skin surface. They most commonly occur on the face—particularly around the eyelids, cheeks, forehead, and temples—though they can also appear on the torso and genital area. Milia are completely benign lesions with no malignant potential; however, in adults, they rarely resolve spontaneously and often present a significant cosmetic concern.
Prosak - what is it
Milia are the result of a disruption in the normal keratinization process of the epidermis, which is the hardening of the cells in the surface layer of the skin. Unlike comedones:
- they do not contain sebum,
- they are not associated with the activity of Cutibacterium acnes bacteria,
- they are not a component of acne vulgaris,
- they do not have an opening that allows spontaneous emptying of their contents.
Histologically, a milium is a small cyst filled with keratinous material, surrounded by a thin epithelial wall. Depending on the mechanism of formation, they are distinguished as:
- primary milia – developing spontaneously without an identifiable disease cause,
- secondary milia – arising as a result of skin damage, inflammatory processes, dermatological procedures, or diseases involving disruption of the epidermal continuity.
Milia can occur singly or in clusters and tend to persist for long periods, especially in adults.
Prosak – causes
The formation of milia is multifactorial and does not result from a single, isolated mechanism. The best-documented causes include:
- disorders of keratinocyte differentiation, leading to excessive skin keratinization,
- impaired exfoliation of the stratum corneum, promoting the closure of hair follicle openings,
- use of occlusive cosmetics, especially around the eyelids,
- chronic UV exposure, causing skin thickening and photoaging,
- skin injuries (burns, laser treatments, peels, dermabrasion),
- dermatological diseases involving blisters or erosions,
- genetic predispositions and individual skin structural characteristics.
Contrary to common myths, milia are not the result of poor hygiene, “clogged pores,” or improper skin cleansing.
Milia – how to remove
The procedure for dealing with milia is aesthetic in nature, but the method of removal should be based on medical and dermatological principles. In adults, milia rarely disappear spontaneously, so effective treatment involves mechanical or procedural removal of the lesion.
Methods considered effective include:
- manual removal of milia after controlled puncturing of the epidermis, performed exclusively in medical settings,
- exfoliating treatments that normalize the keratinization process,
- laser techniques, allowing for precise removal of the cyst without damaging surrounding tissues,
- electrocoagulation for single, well-defined lesions.
It should be clearly emphasized that:
- self-extraction of milia increases the risk of scarring and pigmentation,
- improperly selected cosmetic products do not remove the lesion, they only mask the problem,
- the eyelid area requires special care and experience from the person performing the procedure.
Treatments for milia
In the treatment of milia, procedures are used that allow for precise removal of the lesion and improve the functioning of the epidermis, which reduces the risk of recurrence. Depending on the location, number, and depth of the lesions, the following are used:
- spot or fractional laser treatments, allowing for selective removal of the cysts,
- controlled chemical peels with keratolytic effects,
- medical cosmetology procedures, designed for thin and sensitive skin,
- therapies supporting epidermal regeneration and normalizing the keratinization processes.
Each method should be preceded by a clinical assessment, and the choice of technique depends on the location of the milia, skin type, and history of previous treatments. Properly conducted treatment allows for effective removal of the lesion with minimal risk of complications.
