What are milium cysts?
These are superficial accumulations of keratin, the protein that flakes from the skin naturally. They form when the skin is retained at the mouth of the pilosebaceous glands in their outermost part. Milium cysts are completely benign and do not pose any health problems, beyond aesthetic discomfort.
What do they look like?
They manifest as white papules with a cupuliform surface of 1-3 mm, and appear in isolation or in groups. The patient describes them graphically as “white balls“. They usually appear on the face (around the eyes) and on the eyelids.
Why do they appear?
Most of them are of unknown cause and constitute a tendency of some skins to form these accumulations of keratin. They can rarely be associated with any skin disease (always accompanied by other signs), trauma or taking medication.
What is the treatment for milium cysts?
Ideally, the treatment should be carried out in the Dermatology consultation, since drainage or destruction of them is usually required. Without an incision they usually do not disappear, therefore it is not advisable to squeeze them at home or by means of a “skin cleansing”.
It is possible to drain them by puncturing them with a 10G needle, a No. 11 scalpel or using a lancet. Once the opening has been made, the contents are drained without major difficulty with a teaspoon without leaving a mark. The drainage of milium cysts, despite being the usual treatment, has two basic drawbacks. By draining the cyst capsule remains intact, so they usually reappear in the same place after a few weeks or months. Another disadvantage is that the cyst usually settles on the eyelid or near the eye, an area where it is very difficult to apply pressure to squeeze out its contents or puncture it, with the inherent risk of this process in such a noble area.
For these reasons, it is advisable to perform the removal of milium cysts with aCO2 laser. Regarding drainage, it does not have the drawbacks mentioned above: it can be applied in noble areas if it is handled with precision and allows the complete removal of the capsule: the lesions do not recur. It is a comfortable process for the patient. If the lesions are few, it is possible to perform it without the need for local anesthesia. If there are numerous lesions, it is usually recommended to apply an anesthetic cream prior to the laser session.
Removal through the use of other devices such as curettage or electrocoagulation can leave a scar, for this reason they are methods that we advise against most of the time.
What are the advantages of treating milium cysts withCO2 lasers?
There are basically 4:
1. It can be applied to any delicate area without the use of a needle or a sharp instrument.
2. It is useful for milium cysts that settle in soft areas such as the eyelid, in which it cannot be squeezed to make a mechanical drainage of the cyst.
3. It offers minimal scarring risk compared to other surgical methods.
4. It allows the milium cyst capsule to be completely removed, reducing the possibility of it reappearing in the same place.
How isCO2 laser treatment performed?
The removal of milium cysts with laser is relatively simple: if the lesions are isolated, it is not necessary to apply any type of anesthesia. If they settle in delicate areas such as the eyelids, an anaesthetic cream can be used prior to the session. Afterwards, the lesions are removed one by one gently. After the removal, a minimal punctate crust forms that comes off in a few days. You only have to be cautious with sun protection using SPF 50.
Can they respawn after laser removal?
If the capsule is completely removed, it is very unlikely that the same lesions will reappear. However, having milium cysts is more of a trend than a one-off problem: it is possible that in the future other new cysts will appear in a different or contiguous area. To minimize this risk, retinoids (vitamin A derivatives) can be used topically (tretinoin) or orally (isotretinoin). The latter option is recommended if the patient suffers from severe seborrhea or concomitant acne. Likewise, regular chemical peels reduce the risk of comedones and milium cysts.
Can theCO2 laser remove other types of skin lesions?
Yes, it is possible to treat numerous lesions that are protruding on its surface: ruby spots, seborrheic keratosis, syringomas, soft fibroids, intradermal melanocytic nevi and epidermal nevus, among others. In the Dermatology consultation, these doubts can be clarified and confirm if the lesion in question is susceptible to being treated withCO2 laser.
REFERENCES
Pozo Jd, Castiñeiras I, Fernández-Jorge B.Variants of milia successfully treated with CO(2) laser vaporization. J Cosmet Laser Ther. 2010 Aug; 12(4):191-4.