Infected Milia: What to do?

Milium cysts are subcutaneous pimples that are hard to the touch and contain keratin. These small bumps are not dangerous and often disappear on their own. Indeed, they do not require any special treatment. However, there are solutions if these microcysts become too bothersome aesthetically. This can include, among other things, a mechanical extraction of the milium cyst .

It's important to understand that a milium cyst is closed, unlike other blemishes such as blackheads. Indeed, it generally results from poor exfoliation of dead skin cells, which leads to the obstruction of hair follicles and thus the formation of a layer of skin above that traps them. Given that an infection occurs through the skin penetration of an infectious agent, this means that the milium cyst must first be pierced. It can particularly be opened by scratching its surface, aggressive exfoliation, or by using extraction tools such as a needle.

When one manually manipulates a milium grain or uses self-administeredmilium grain extraction tools (extractor, needle or curette) that are not aseptic, these actions pose risks of contamination and therefore infection of the microcyst. Non-compliance with hygiene rules, such as poor hand washing or inadequate sterilisation of tools, especially when the procedure is carried out by an untrained person, creates a fertile ground for the development of bacteria, fungi and viruses. Once the milium grain is pierced, these contaminants can enter through the wound under the skin and cause infections.

Among these, we can potentially find follicular pyodermas, characterised by a bacterial infection of the hair follicle where milium grains are located. They are caused, among other things, by the bacterium Staphylococcus aureus. Examples include folliculitis, boils and anthrax, which is more serious. However, these scenarios have not been scientifically proven.

Let us remind you that it is strongly advised against removing a milium cyst by yourself, as this behaviour exposes you to infections. If you wish to get rid of it, turn to a dermatologist who is qualified to do so in a safe manner.

If you notice redness, a change in the appearance of the milia, pain, unusual local signs, or even fever on the affected areas, seek medical advice promptly so that your doctor can determine the appropriate treatment for your case, which will likely involve the prescription of oral antibiotics. Do not attempt to touch the infected milia, as you risk worsening the situation.

• BERK D. R. & al. Milia: A review and classification. Journal of the American Academy of Dermatology (2008).

• BARBAROT S. & al. Les grains de milium de l’enfant. Annales de dermatologie et de vénéréologie (2009).

• TROUCHE F. Les infections bactériennes. Dermato-Info (2019).

• GALLARDO AVILA P. & al. Milia. StatPearls (2023).