Retin-A for milia/syringoma? (Photo)

Question

Black 28F. i thought i had milia under my eyes but upon further research i believe it is syringoma. i've been looking into treatments and have seen erbium laser as one, but i am concerned about discoloration under my eyes. I've just started using Medik8 r-Retinoate eye serum because i thought i had milia. i've read online nothing topical will help syringoma but would like other opinions

Nelson Lee Novick, MD · Answer

You are quite on the mark in your concern about the use of lasers in skin of color. There is a real risk for subsequent permanent dyspigmentation. For decades, I have been successfully been treating this problem with light electrocautery, as well as treating another common condition in skin of color, known as dermatosis papulosa nigra (DPN) in this way. The area is numbed with a local anesthetic following which numerous lesions can be treated and flattened in literally a matter of a couple of minutes. Before falling prey to the expense and risks of smoke and mirrors lasers, you would be wise to consult with an experienced, board certified cosmetic dermatologist with experience with electrocautery treatments and not simply hawking the expensive, supposedly "next big thing" laser to come along. Best of luck.

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. Based on your concerns, I recommend treatments with CO2 resurfacing lasers in the area of concern to help smooth out the texture of your skin. CO2 lasers can be used to target and vaporize the syringoma and/or milia tissue, leading to their removal. This is a great and effective treatment. I hope this helps and best of luck!

Anna Chacon, MD, FAAD · Answer

Retin-A (tretinoin) is a topical retinoid commonly used for a variety of skin conditions, including acne, photoaging, and sometimes for milia. However, its effectiveness for syringoma is questionable.

Milia vs. Syringoma
- **Milia** are small, white, keratin-filled cysts that are often found around the eyes and on the face. They can sometimes be treated with topical retinoids like Retin-A, which help in the turnover of skin cells.
- **Syringomas** are benign tumors derived from the sweat ducts, typically appearing as small, flesh-colored to yellowish papules, often around the eyes. They do not respond well to topical treatments because they are deeper in the skin.

Treatment Options for Syringoma
1. **Laser Therapy**: Erbium laser is one option, but as you mentioned, it can carry risks of discoloration, especially in sensitive areas like under the eyes.
2. **Electrosurgery**: This involves using electrical currents to remove the lesions. It can be effective but also carries risks of scarring and pigmentation changes.
3. **Cryotherapy**: Freezing the syringomas can be an option, but it also comes with risks of pigmentation changes.
4. **Surgical Excision**: In some cases, a dermatologist may recommend surgical removal, though this is typically reserved for more severe cases.
5. **Topical Retinoids**: While not typically effective for syringomas, they can improve the overall texture and health of the skin, which might help in some cases with very superficial lesions.

Your Current Approach
- **Medik8 r-Retinoate Eye Serum**: This is a retinoid-based product that may help with skin texture and overall appearance but is unlikely to have a significant impact on syringomas.
- **Consultation with a Dermatologist**: Given the complexity and the specific nature of syringomas, a consultation with a dermatologist is highly recommended. They can provide a definitive diagnosis and recommend the most appropriate treatment options based on your skin type and condition.

Concerns About Discoloration
If you are particularly concerned about discoloration, it's essential to discuss this with your dermatologist. They can tailor the treatment plan to minimize risks and may recommend options like pre-treatment with skin-lightening agents or post-treatment care to reduce pigmentation changes.

1. **Topical Retinoids**: Unlikely to be effective for syringomas but can improve skin texture.
2. **Laser Therapy**: Effective but carries risks of discoloration.
3. **Other Treatments**: Electrosurgery, cryotherapy, and surgical excision are alternatives.
4. **Dermatologist Consultation**: Essential for accurate diagnosis and tailored treatment plan.

Always seek professional advice before starting or changing treatments, especially for conditions involving the delicate skin around the eyes.

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