Conditions · Lesions & Growths

Milia

A milium is a keratin-filled cyst sitting under the epidermis with a complete epithelial lining and no opening to the surface.

Mechanism

What is actually happening

Histologically identical to an epidermoid cyst, only far smaller — 1 to 2 mm, most often periorbital. Primary milia arise spontaneously; secondary milia follow burns, blistering, procedures or topical steroids.

The distinction

How it is told apart

Milia are not whiteheads. A closed comedone is a plugged follicle with a channel to the surface. A milium has no channel — which is why extraction and acne treatments do nothing.

Assessment

What is established first

Primary versus secondary, distribution, any recent procedure or topical steroid use, and whether the pattern suggests an underlying cause.

Approach

What is typically done

De-roofing with a sterile blade or fine needle, then expression. Electrodesiccation, curettage and ablative laser are alternatives. All work by creating the opening the anatomy does not provide.

When treatment waits

When it is deferred

Squeezing causes trauma, and trauma is a documented cause of secondary milia. Forcing them can produce more.

Full guide: milia removal in Singapore →

Frequently asked

What is milia?

A milium is a keratin-filled cyst sitting under the epidermis with a complete epithelial lining and no opening to the surface.

How is milia told apart from similar conditions?

Milia are not whiteheads. A closed comedone is a plugged follicle with a channel to the surface. A milium has no channel — which is why extraction and acne treatments do nothing.

What is assessed before treating milia?

Primary versus secondary, distribution, any recent procedure or topical steroid use, and whether the pattern suggests an underlying cause.

When is treatment deferred?

Squeezing causes trauma, and trauma is a documented cause of secondary milia. Forcing them can produce more.

Have this assessed

Every assessment is carried out personally by Dr Sin Yong, Medical Director. 9 Scotts Road, #12-01 Pacific Plaza.

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