Milia en plaque

Abstract

Milia en plaque (MP) is an uncommon skin condition, usually occurring in periauricular distribution, due to confluence of whitish smooth milia with formation of typical plaques. Lesions are usually asymptomatic, but in a minority of cases a slight sensation of burning or itching has been referred. Histologically MP is formed by laminated keratin-filled small cysts presenting at their periphery a few layer of flattened basaloid cells. Diagnosis is usually a clinical one; differential diagnosis can include milia secondary to a blistering disease, milia secondary to topically applied perfumes, or due to topical drugs, as corticosteroids or 5-fluorouracil, or oral drugs as benoxaprofen, milia after radiotherapy or mechanical traumas as well as other pathological skin conditions like familial or naevoid comedo sindrome, Favre-Racouchout disease, lichen planus tumidus folliculans. Oral minocycline or etretinate, topical tretinoin, electrodesiccation, CO2 laser, all have been proposed to treat MP, but oral therapy in some instances could be judged excessive, while topical retinoids can give rise to heavy inflammation and electrodesiccation and laser can lead to poor aesthetic results. A 32-year-old woman who presented with primary MP with bilateral retroauricolar localization was treated with cryosurgery, a single freeze-thaw cycle of 75 s. In about 8 weeks complete healing was observed in both areas. After 2 years of follow-up no recurrence was observed with no pigmentary side effects and a very good aesthetic results. Open spray cryosurgery can be suggested as first choice treatment for MP, this method appearing a safe, effective, well-tolerated, time-sparing and not expensive therapy.