Isotretinoin-Associated Eruptive Milia: A Rare Adverse Effect

Isotretinoin is a widely used systemic retinoid for the treatment of moderate-to-severe acne vulgaris. While its common cutaneous side effects include dryness, cheilitis, and photosensitivity, eruptive milia is a rarely reported adverse event. Awareness of such uncommon associations is important for dermatologists managing patients on isotretinoin. A 17-year-old male with moderate-to-severe acne vulgaris was initiated on oral isotretinoin at a dose of 30 mg daily. After two months of therapy, he developed multiple tiny, white, dome-shaped papules localized to the upper cheeks, mainly below the lower eyelids. Approximately 20 lesions were noted, clinically consistent with milia. There was no history of preceding trauma, cosmetic product use, or dermatologic procedures. Isotretinoin treatment was continued, and the milia were managed with simple manual extraction, leading to complete resolution without recurrence. Milia are superficial keratin-filled cysts that typically arise in response to skin injury, inflammation, or certain topical agents. Although isotretinoin is known to modulate follicular keratinization, its role in the development of eruptive milia is not well understood. The temporal relationship in this case supports a possible drug-induced effect. Only a few similar cases have been reported in the literature, suggesting this may be an underrecognized side effect. Continuation of isotretinoin appears to be safe, and milia can be effectively managed with conservative extraction. Eruptive milia may occur as a rare side effect of isotretinoin therapy. Recognizing this benign condition can help clinicians reassure patients and avoid unnecessary discontinuation of treatment.