Chronic tophaceous gout is a manifestation of longstanding, untreated hyperuricemia, characterized by monosodium urate crystal deposition in soft tissues and joints. While commonly presenting as nodular or papular tophi, rare morphologic variants such as miliarial gout may occur. We present a case of a 35-year-old Filipino male who presented with classic cutaneous manifestations of chronic tophaceous alongside numerous widespread, milia-like papules containing chalky tophaceous material, consistent with miliarial gout. This distinct and uncommon variant has only been reported in a few cases worldwide. Notably, the patient had a history of prolonged unsupervised corticosteroid use, renal insufficiency, and poor compliance to urate-lowering therapy, all of which may have contributed to the rapid and extensive cutaneous involvement. This case highlights the importance of early recognition of atypical gout presentations and emphasizes the potential role of corticosteroids in modifying disease progression and morphology.