Introduction 

One may have come across someone with milia or might as well experience one themselves without fully understanding what it is and its effect on affected individuals. Attention is not placed on Milia because of the insufficient clinical value of the skin condition. Milia is a harmless skin condition, it appears as small white lumps that develop beneath the skin surface caused by trapped dead cells from the skin that harden into lumps or cysts.¹ Milia is a common skin condition in infants having 40-50% occurrence and may also occur in adults, it may last for a few weeks and disappear completely.

Classification of milia 

Milia may be spontaneous or may be associated with various processes. This section highlights the different forms of milia classified. They include:^1,2

Primary milia

This form of milia occurs spontaneously, majorly around the face, scalp and palate. A percentage of this type of milia is also linked to certain inherited skin disorders, a rare genetic condition (genodermatosis). The following are multiple subtypes:

• Congenital milia: they appear as one or more lesions and heal by themselves in weeks or months. It occurs as whitish-yellow cysts around the nose and upper lip in 40% to 50% of neonates but is less common in premature infants and may develop later
• Benign primary milia of children and adults: the lesions of the benign primary milia of children and adults occupy mostly the forehead, cheeks, eyelids, and genitalia. Compared to congenital milia, it lasts longer. Several studies have also reported the appearance of the benign primary milia of children and adults on the nasal crests, areola, and vulva
• Milia en plaque: it is a rare skin disorder, that has less than 30 reported cases. They occur as plaque of milia in the preauricular area (areas surrounding the external ear)
• Nodular group milia
• Multiple eruptive milia
• Nevus depigmentosus with milia
• Genodermatosis associated 

Secondary milia

This form of milia is acquired, it is associated with underlying conditions which may be disease and medication-linked. This form persists and requires treatment. There are three subtypes of the secondary milia:

• Medication-associated milia: this form of milia as the name implies results from medication use that is a side effect of a medication. Among these medications are benoxaprofen, topical steroids, cyclosporine, 5-fluorouracil, and penicillamine
• Disease-associated milia: examples of this form of milia are subepidermal postbullous milia, tarda porphyria cutanea, herpes zoster, bullous pemphigoid, lichen sclerosus, Stevens-Johnson syndrome, bullous erysipelas, dermatitis herpetiformis, lichen planus, leprosy, leishmaniasis, phototoxic reactions, Sweet syndrome, and bullous lupus erythematosus
• Trauma-associated milia: trauma-associated secondary milia in children frequently presents as traumatic superficial abrasions. Additionally, Second-degree burns, dermabrasion, radiation, chemical peels, skin transplants, and ablative laser therapy are traumatic causes of secondary milia

Causes of milia 

There are many causes, which include:

• The accumulation of keratin and dead skin cells under the skin's surface, frequently due to insufficient exfoliation, leads to primary milia
• Newborns with congenital milia have undeveloped sweat glands that are prone to blockage
• Secondary milia are a result of Skin damage, several medical problems, and long-term topical steroid use
• Individuals may also be predisposed to milia by rare genetic abnormalities, particularly in younger people

The psychological effect of milia

The currently available studies do not show any significant psychological impact milia has on patients' quality of life. To clearly state the effect of milia on factors like self-esteem, social functioning, and well-being of the patient, further studies are needed. Given the benign nature and high incidence of milia, the psychological effects tend to be minimal in most cases. 

The social impact of milia

Milia is commonly found in young babies and the prevalence rates help reduce the social stigma surrounding milia as people pay minimal attention to the skin condition. Milia primarily is not harmful, aside from the physical lumps, it is not itchy nor has any form of physical disruption on the face and skin. This results in no tremendous effect on social confidence in public functions. Although some people may feel uncomfortable and self-conscious about their looks, they may request cosmetic products to help but generally, treatments are not essential for milia. The importance of addressing the psychological and social effects of milia. 

Coping systems designed to address milia

Coping systems in this context refer to the mechanisms one can adopt in managing milia. More research will be needed to demonstrate the effectiveness of these coping strategies as there are minimal reports on the socio-psychological impacts of milia on people. Listed below are strategies that would help in the management of milia:^1,2,3

• Emotional coping strategy
• Problem-solving coping strategy
• Adoption of healthy habit
• Treatment for secondary milia

Emotional coping strategy 

• Applying mindfulness and meditation as relaxing techniques to ease stress.
• Taking an interest in self-care practices that will sustain one’s body, mind, and soul.
• Requesting emotional support and affirmation from friends, family, or professionals will make one feel good about themselves.

Problem-solving coping strategy

• Focusing your mind on things that are within your power to control will help boost your confidence and lower anxiety
• Seeking for milia therapy, such as extraction, topical retinoids, or treatments, if needed for aesthetic purposes from experts or professionals

Adoption of healthy habits

• Maintaining a healthy lifestyle such as; having a balanced diet, regular exercise, adequate sleep, and stress-relieving activities
• Avoiding bad coping strategies like abusing drugs or alcohol excessively is an important aspect of managing milia

Treatment for secondary milia

Since secondary milia tend not to resolve on their own, it is essential to obtain therapy from dermatologists or health experts which may involve surgical evacuation of simple milia or the employment of electrocautery, as well as topical retinoids for numerous multiple milia.

Frequently asked questions (FAQs)

Is milia contagious?

No, milia is not contagious. It is harmless and cannot spread from person to person.

What can cause milia?

Milia occurs as a cyst in the face or other areas of the skin due to the accumulation of dead cells underneath the skin. In newborns, it has no specific cause but in older people, it may result from burns from exposure to sunlight, prolonged use of steroid creams, genetic conditions or autoimmune response. 

How can I prevent milia?

Essential steps in preventing milia include using sunscreen, moisturizing, gently cleaning, and exfoliating regularly. Also, visiting a dermatologist can assist in identifying the reason behind recurrent milia and creating a successful treatment strategy. 

How can one treat milia in children?

In infants, milia resolves within weeks to months and may not need extensive treatment. Avoid picking the lumps that may result in scars, gently wash the affected area and if necessary visit the dermatologist for further recommendations.

Is it recommended to remove milia at home?

Do not attempt removing milia on your own, it may scar your skin and get infected. It is recommended to wash the affected with warm water and soap, use sunscreen while outside and visit a dermatologist.

Summary 

The high prevalence of milia has resulted in minimal attention being placed on the skin condition. In some people, this may be uncomfortable but cosmetic products are recommended by dermatologists to help boost themselves. Additionally with emotional support from friends and families, as well as adopting healthy lifestyles, one can cope with milia.