Milia en Plaque

the affected areas are behind my ears and all along the scalp line (back of head/ 2''swath).  Beside retinol which I use with little result.....what can I do.  Very itchy and burns when I scratch.


F, Maine

Milia are raised, keratinized cysts that appear around the face and neck. They typically arise from the sebaceous glands, sweat ducts or the vellus hair follicles. Milia en plaque (MEP) is most common among middle-aged women.


Because there are many possible presentations of milia en plaque, the best course of treatment will depend on the specifics of each individual case. Non-surgical treatment options include topical tretinoin, oral etretinate, photodynamic therapy, electrodesiccation, and laser treatment.

In most cases milia en plaque is a non-serious condition but it often represents a frustrating cosmetic issue. In some cases, milia can accompany more serious inflammatory skin diseases. Even though most milia are benign, it's a good idea to have a skin biopsy to rule out a rare possible malignancy of the follicular infundibulum.

We have achieved excellent treatment results using a CO2 laser to resurface the affected area and restore a natural, smooth contour to the skin under the plaque. My advice is to meet with a board-certified plastic surgeon to review the histopathological findings of your case and select a treatment option that makes sense for you.

As you probably know, milia en plaque (or MEP) is a rare type of primary milia in which milia are grouped closely and form a raised, erythematous plaque on the surface of the skin.

There are several available treatments which can help remove or reduce the appearance of these keratin-filled cysts. Treatment options include cryotherapy, dermabrasion, topical retinoids, electrodesiccation, and laser therapy. In most cases, the best option for treating milia en plaque is with a CO2 laser.

We have had excellent success treating both pediatric and adult primary and secondary milia -- but keep in mind that no treatment is truly permanent. It's always possible for milia to return at a later date.

Without a physical examination, I can't say with any certainty which treatment option makes the most sense for you. For best results, I encourage you to schedule an appointment with an experienced dermatologist who is a member of the American Academy of Dermatology and who has experience treating multiple milia types.