John R. Tkach, M.D.
300 North Willson, Suite 203B
Bozeman, MT 59715
(406) 587-5442


Patient Information Sheet

What are milia, how does Dr. Tkach treat them, and what is their significance?

Milia are tiny superficial cysts that occur around the eyes, eyelids, cheeks, sides of the face, and forehead. They are white or yellowish-white bumps about 1 to 6 mm in size. They may seem like whiteheads to you, but you cannot squeeze them out. They are tiny cysts. Although they usually occur after age 40, I have seen a few teenagers with milia.

A milium is a basketball-shaped cyst, a piece of skin that is trapped under the skin. The white material in the cyst is accumulated dead skin. It is like a hollow little basketball. The wall of the basketball is growing skin. The outer layer of dead skin is on the inside of the basketball. That is the cyst wall. To get rid of a milium, we must also remove the cyst wall. Milia are not dangerous. They are annoying and cosmetically distracting.

No one knows the cause except to blame it on heredity. It may be that milia are derived from the tiny hairs (vellus hairs) that occur on the face. Sometimes minor injuries such as abrasions, heat burns, and sunburns will produce milia during the healing process. In such cases, the outer layer of skin, the epidermis, may grow over the vellus hair follicle during healing, seal it off, and produce a superficial cyst. My feeling is that most milia are somehow caused by sun damage.

My experience with milia is that those caused by burns, abrasions, and surgery tend to be temporary.

Treatment Options

  1. Do nothing. This is not a bad choice except that it does nothing to improve the problem.
  2. Incision and drainage. This is the best treatment in my experience. I use a small sterile needle to make a superficial nick over the cyst. I then use a small instrument used to pinch out blackheads to press the sides of the cyst and pop it out. If the cyst wall comes out with the cyst, and it usually does, then that cyst will not regrow. But there is a tendency to get new cysts with time. Incision and drainage of cysts usually does not require anesthesia. Treated areas usually heal without leaving scars.
    f the cyst wall does not come out, the cyst may regrow. Occasionally, I will use a small spark of electricity to get rid of such small remnants of cyst wall.
    The limitation to this treatment is that it is hard to pinch out very small cysts 1-2 mm. It works better if the cyst is about 3 mm.
  3. Creams, lotions, soaps, scrub brushes, and liquid nitrogen. Sorry. These do not work. However, I have noticed that some people using Retin A cream for sun damage have a decrease in milia. It is a slow improvement.

Reasons for Treating Milia

  1. Cosmetic
  2. Confusion with Basal Cell Cancer. Sometimes it is hard for me to tell the difference between a milium and skin cancer. Over the past 34 years, I have excised about 10 milia thinking they were cancers. If the milia are of the sort that may be confusing, and if they are easy to treat, it is worth simple incision and drainage.

Favre-Rocouchot Syndrome (Nodular Elastosis)

Possibly a variation on the theme of milia is Favre-Rocouchot Syndrome. In this condition, blackheads, whiteheads, and cysts occur around the eyes in areas of sun-damage. It is accompanied by sun-induced wrinkles. There may also be precancerous actinic keratoses. Favre-Rocouchot syndrome seems to me to be a sort of sun-damage-induced acne. Like teenage acne, it often improves with Retin A.

The information provided in these patient information sheets is offered for general informational and educational purposes only; it is not offered as and does not constitute medical advice. In no way are any of the materials presented meant to be a substitute for professional medical care or attention by a qualified practitioner, nor should they be construed as such.

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