Selected treatment methods for colloid milium – a literature review

Abstract

Introduction and aim. Colloid milium is a rare degenerative skin condition of unknown origin. Typically, it affects sun-exposed areas of the skin. Nevertheless, non-sun-exposed areas may also be affected. Clinically it presents with yellow or red papules, filled with gelatinous masses. There are four subtypes of colloid milium, each with its distinct characteristics: adult, juvenile, nodular, and pigmented. Although diagnosis is primarily clinical, skin biopsy and various staining techniques are required to exclude similar diseases. There is no single effective treatment for colloid milium. Most methods involve the use of lasers, dermabrasion, and oral medications. Yet, the final results differ. Since this topic has not been addressed very frequently in recent literature, the purpose of this review is to present the currently available treatment methods for colloid milium.

Material and methods. A literature review was performed to identify the most efficient treatment approaches for colloid milium, focusing on their effectiveness in eliminating nodules and preventing recurrence.

Analysis of the literature. Due to its rarity and consequent lack of extensive scientific research, the number of available therapy options for colloid milium is limited. Commonly used treatment methods include lasers, oral medications, dermabrasion, and photodynamic therapy. Microablative fractionated CO2 laser treatment resulted in complete ablation of the lesions with no recurrence. Non-ablative fractional resurfacing after multiple therapies led to the total elimination of the lesions, with no signs of reappearance during follow-up. Dermabrasion required a lengthy healing process. During follow-up no new papules were detected. After multiple sessions of treatment with MAL-PDT, the skin was devoid of nodules and recurrence was prevented. Following full recovery, treatment with the long-pulsed ER:YAG laser revealed the skin without any textural changes, scars, or pigmentation. During follow-up, no new papules were reported. Oral medication provided insignificant results. The majority of patients undergoing these procedures did not need preparation or analgesia. However, non-ablative fractional resurfacing required topical analgesia with 30% lidocaine gel, long pulsed Er:YAG laser treatment demanded intravenous sedation, and dermabrasion involved axillary block analgesia. None of the procedures provoked adverse effects.

Conclusion. Skin lesions caused by colloid milium may provoke esthetic concerns, prompting patients to remove them. However, available treatments methods are limited and yield varying outcomes. Among the prominent procedures are microablative fractionated CO2 laser, non-ablative fractional resurfacing, long pulsed ER:YAG laser, and treatment with MAL-PDT, which led to complete ablation, required minimal convalescence time, and provided long-lasting remission. Dermabrasion displayed partial results, with no observed relapse of colloid milium during follow-up. Oral treatment presented the least significant results. Further research is necessary in order to develop new treatment methods for colloid milium that are safe, effective, and affordable.