Background: Bullous pemphigoid (BP) is the most common autoimmune subepidermal blistering disorder, predominantly affecting the elderly. Healing usually occurs with post-inflammatory hyper- or hypopigmentation, but the development of milia is rare and more often associated with epidermolysis bullosa acquisita (EBA).

Case Presentation: We report a 60-year-old woman with chronic bullous pemphigoid, who, during the healing phase, developed widespread and numerous milia diffusely involving the trunk and extremities. Milia were present over more than 40% of body surface area, with hundreds of dome-shaped pearly white papules ranging from 1–5 mm, clustered over previously involved sites, including the arms, legs, dorsum of feet, trunk, and peri-umbilical region. Diagnosis was confirmed by skin biopsy demonstrating keratin-filled cysts.

Conclusion: Milia formation, although uncommon in BP, may occur extensively and mimic other immunobullous disorders such as EBA. Awareness of this rare sequela is essential to avoid diagnostic confusion and to guide appropriate patient counseling