These are multiple tiny 'pin-head' papules or bumps on both cheeks with background reddness on the cheeks. These 'pin-head' papules are whitish in color.
The chronic history and appearance described above suggest that the diagnosis is milia. These are tiny keratin cysts on in the epidermal (top) layer of the skin.
The cause is usually unknown, but can be due to injury to the skin, chronic sun exposure or even aging.
As milia is benign, it can be managed conservatively or treated with a course of oral isotretinoin, due to the extent of involvement. This will increase the turnover of the epidermal layers of the skin and result in exfoliation of these tiny cysts.
If they occur singly, I normally use a sterile needle to lance out the tiny keratin pearl.
