Fractional photothermolysis for the treatment of adult colloid milium.

An otherwise healthy 54-year-old white man presented for evaluation of a long-standing, progressive eruption on his cheeks. On physical examination, the affected areas showed large yellowish plaques composed of minute pseudovesicular lesions (Figure 1). The patient admitted to a long history of unprotected sun exposure. His medical history was negative for photosensitizing medications and disorders, and there was no family history of similar skin findings. A biopsy specimen, which was obtained from a representative area on the left cheek, revealed deposition of eosinophilic hyalinized material within the papillary dermis. These large collections distended the dermal papillae, and the hyalinized material showed fracturing artifact. The results of Congo red staining were positive. These findings supported the diagnosis of adult colloid milium (CM). The patient underwent a workup, including a complete blood cell count, metabolic profile, erythrocyte sedimentation rate, and serum protein electrophoresis, and the results were all within normal limits. The patient had previously undergone treatment with topical retinoids, without benefit. He had been offered carbon dioxide laser resurfacing but had declined because of the associated risks and prolonged recovery period.