Milia extraction and a Prurigo Nodularis

This patient had a few small firm bumps on the right side of her neck that have really been bothering her, so she requested removal.
I thought the first one was just a picker’s nodule, also called a prurigo nodular, which is essentially a bump that is thickened and firm because it is manipulated often – the patient is picking and pulling at the area to create a bump on the skin. We see this often in our patients.
However, I was proven wrong, or maybe partly incorrect. I think the area was thickened due to chronic picking of the area, but there was a small milium buried under there that I was able to get to.
Remember, milia are just superficial cysts, they are benign very common growths that don’t have to be removed and are difficult to remove at home because the skin surface often has to be nicked first, in order to properly express the milia.

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