Journal of Asia Pacific Aesthetic Sciences

ABSTRACT: Milia en plaque (MEP) is a rare variant of primary milia characterized by multiple grouped milia arising on an erythematous plaque. Its etiopathogenesis remains unclear, although some cases have been associated with genetic and autoimmune conditions. We report the case of a 22-year-old Filipina with a 10-month history of an erythematous facial patch with papules and pustules, which progressively evolved into an erythematous plaque with multiple red and white papules. An initial diagnosis of MEP, likely secondary to papulopustular rosacea, was made, and a skin punch biopsy was performed for confirmatory diagnosis. Histopathological examination revealed epidermal spongiosis with a dense dermal nodular granulomatous inflammatory infiltrate composed of lymphocytes and histiocytes, along with small milia-like cysts. A definitive diagnosis of MEP secondary to granulomatous rosacea was established. The patient was treated with low-dose oral isotretinoin and azithromycin, together with topical metronidazole, azelaic acid, trifarotene, ivermectin, and serial milia extraction. Treatment adjustments, including discontinuation or modification of topical agents, were made based on clinical response. Complete resolution was achieved through combined management targeting both the MEP (topical retinoids and extraction) and the underlying rosacea. This case highlights the importance of careful clinical assessment and histopathological confirmation in diagnosing rare dermatologic conditions such as MEP associated with more common but potentially underdiagnosed inflammatory dermatoses.