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Milia are very common, benign, keratin-filled cysts. These tiny epidermoid cysts are derived from the pilosebaceous follicle. Primary milia arise on facial skin bearing vellus hair follicles. Secondary milia may result from damage to the pilosebaceous unit.
Simple removal of milia can be done by gently opening the skin above the milia with a sterile lancet or needle. Milia will typically pop out when pressure is applied with a comedone extractor or forceps. Dermatologists may also prescribe retinoid creams, or advise microdermabrasion.
Future milia formation can be minimized by avoiding heavy moisturizers, using oil-free sunscreen and limiting heavy hairspray or hairgel.
Often mistaken for milia is another skin condition, sebaceous hyperplasia (shown below). Instead of a firm white or yellow bump, sebaceous hyperplasia displays a firm yellowish or white border around the center and a depressed middle. Physicians should be consulted when these present for diagnosis, as they may also be mistaken for basal cell carcinoma.
Sebaceous hyperplasia is completely benign and does not require treatment; however, lesions can be cosmetically unfavorable and sometimes bothersome when irritated. Treatments are mostly mechanical. Lesions tend to recur unless the entire unit is destroyed or excised. Risk of permanent scarring must be considered when treating benign lesions.
A biopsy may be necessary if concern exists that the lesion is a basal cell carcinoma. Therapeutic options include photodynamic therapy (with combined use of 5-aminolevulinic acid and visible light),[28, 29] cryotherapy (liquid nitrogen), cauterization or electrodesiccation, topical chemical treatments (eg, with bichloracetic acid or trichloroacetic acid), laser treatment (eg, with argon, carbon dioxide, or pulsed-dye laser),[32, 33] shave excision, and excision. Complications of these nonspecific destructive therapies include atrophic scarring or transient dyspigmentation.
Oral isotretinoin has proven effective in clearing some lesions after 2-6 weeks of treatment, but lesions often recur upon discontinuation of therapy; maintenance doses of oral isotretinoin in the range of 10-40 mg every other day or 0.05% isotretinoin gel (not marketed in the United States) is rarely indicated as a suppressive treatment for widespread disfiguring sebaceous hyperplasia.[16, 34] Oral isotretinoin should be prescribed by a physician who is experienced in oral retinoid therapy and only for patients without contraindications and fully compliant with all restrictions on this medication. Other topical retinoids are considered less effective in treating this condition. See http://emedicine.medscape.com/article/1059368-treatment