Good Afternoon Dr. Bailey,
I have a question concerning my 5 month old son. Around 3 weeks of life he developed normal baby acne that has subsequently resolved itself. However, he has a patch of milia on his chin that do not seem to be going away. I am not sure if we should just wait it out longer or is there some sort of treatment we can use to help it go away?
Milia are little pockets of dead skin cells that have gotten trapped. The skin actually folds over to encase the dead skin cells in a little sphere within the top layer called the epidermis. I tell my patients to think of them just like a pocket in your jeans, there is a lining made of your normal skin and it’s filled with the same dead skin cells that form and drop off of your skin every day. When milia are new, the dead skin cell collection is soft. The longer the milial pocket of dead cells stays trapped in the skin the harder the milia becomes.
Milia can form in skin spontaneously, but they are even more likely to form when the skin heals after a rash. The skin of babies and children can form milia after any sort of a rash, including baby acne. The skin of these tender and sweet little people is much finer than our tough adult skin. This means that milia in babies and children are not covered by the same thick, tough outer skin layer that they are in adults. It also means that they may well work themselves out just by the friction and rubbing of the skin that happens during the natural course of daily activities. To help assist these little milia in working their way out sooner rather than later, I often recommend doing the routine daily skin cleansing step with a wash cloth. By gently sudsing and rubbing the skin with the wash cloth and a very mild soap such as Toleriane Cleanser there will be a nice bit of exfoliation. The milia are so close to the surface they may gradually open and come out. I also recommend applying a simple moisturizing cream after washing so that the skin stays soft and well hydrated, which will also aid in the natural opening and resolution of the little milia.
Really stubborn milia that refuse to come out on their own can be opened and expressed by a dermatologist, but it hurts and never makes us popular with children or babies. Fortunately, most of the time simply adding the hydrating and gentle exfoliation that I mentioned above does the trick.
Cynthia Bailey MD, Dermatologist
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