What are milia?
I had a reader contact me recently with questions about milia. She had always had beautiful skin until a laser procedure left her with milia, hyperpigmentation and skin damage. My heart goes out to her! So here is everything I know about this skin condition.
Milia are a type of harmless cyst that feels like a small bead beneath the skin. They look like small raised white or yellowish bumps, about 1 or 2 millimeters across. They can occur anywhere on the body, but most often they are found on the skin of the cheeks, nose, around the eyes, eyelids, forehead and chest.
Milia come in groups and when people have a lot of them, skin can look “cobbled.” The cysts are often mistaken for whiteheads. But unlike pimples, they are not formed inside a pore.
Renee Rouleau, Skin Care Expert and Esthetician says, “All the acne spot treatments in the world will never get rid of these, simply because it’s not an infection. Milia can stay there for years [with the same size and shape] if they aren’t removed properly.”
Keratin is a protein found in skin, hair, and nails. Milium cysts form when skin loses its natural ability to exfoliate. The keratin in skin gets trapped, forming tiny cysts just below the skin’s surface. Milia (the plural form of milium) is usually diagnosed by its appearance, but in rare cases, a doctor may request a skin biopsy.
Milia occurs in people of all ages. It forms spontaneously, but we aren’t sure why.
There are different causes of milium cysts. Take note of any changes in your skin care routine that could be responsible for milia. They are often the result of something, like a rash or skin injury, that has affected the skin’s surface.
Things We Think Cause Milia:
- Neonatal milia occurs in about half of all babies soon after they are born. It is so common that it is considered normal. Milia in newborns is usually found around the nose - but may also occur on the scalp, cheeks, upper body and inside of the mouth. They are thought to arise from sweat glands that aren't fully developed or mature. In babies, it clears without treatment.
- Skin diseases like bullous lilchen planus, and blistering disorders, such as Porphyria Cutanea Tarda, may cause these cysts. There are also some extremely rare diseases, Milia en plaque and Multiple eruptive milia, that are not well understood.
- Genetics may make you more prone to milia.
- Heavy Skin and Hair Care Products may prevent epidermal skin cell turnover. Make-up removers not labeled oil-free or non-comedogenic can cause problems. Many women get milia on the skin of their eyelids from makeup use. Some lip products cause milium cysts around the edge of the lips.
- Cumulative Sun Damage is thought to cause milia.
- Damaged or injured Skin can develop milia as the skin heals. Damage to the sweat glands may be an underlying cause. Some examples of skin damage associated with milium cysts in older kids and adults are:
- blistering due to a skin condition
- blistering injuries, such as poison ivy
- skin resurfacing procedures, such as dermabrasion or laser resurfacing. Dr. Arnold R. Oppenheim wrote on RealSelf.com that, "Milia are actually routine following dermabrasion."
- long-term use of steroid creams
- rashes from rosacea, seborrheic dermatitis, or allergic reactions
How can I fix it?
As the surface of the skin is exfoliated, some cysts resolve on their own. However, quite often treatment is needed.
By keeping the epidermis/top layer of skin thin and smooth, you slow milia formation. This condition is treated by removing the oldest, dead skin cells from the skin's surface; but this exfoliation must be done without irritating the skin. (That means DO NOT scrub off the top layer of your skin!) Skin care products like Retin A (tretinoin), retinol, and glycolic acid can reduce the size and number of milia. Facials, mild chemical peels, and a Clarisonic Brush can help too. Some dermatologists have found that a combination of these methods works better than one method alone.
LHA Cleansing Gel combines glycolic acid and salicylic acid. It provides even exfoliation to unclog pores and diminish discoloration, fine lines, wrinkles and rough texture. Wash your face with this gel twice daily to gently exfoliate skin.
SkinCeuticals makes 2 great retinol creams. Learn more in our post, Want Younger-Looking Skin? 3 Ways Retinoids Make Skin Beautiful.
Some people with very sensitive skin are unable to use retinol creams. For them, Retexturing Activator is a great choice to treat and prevent milia. This serum is oil-free and works on all skin types. It hydrates and exfoliates skin for a noticeably softer, smoother texture. 20% glycolic acid breaks the bonds that bind dead cells to the surface of the skin to diminish surface lines and wrinkles.
If exfoliation doesn't work, milium cysts can be manually extracted in a medical office. No anesthetic is needed. The skin is cleaned with an antiseptic. The skin over the cyst is lanced with a sterile needle. Pressure is applied around it with a comedone extractor to make the keratin deposit pop out. Because this procedure carries the slight risk of scarring, skin damage and infection, it is not recommended that you do it yourself.
Other methods a dermatologist may use to treat milia include:
- Cryotherapy, which freezes the cyst
- Mild chemical peels can be used to remove the top layer of skin cells - and the cysts. Learn more in our blog post on chemical peels.
- Retin A is a prescription form of Vitamin A that speeds up your skin cell turnover
- Minocycline, an antibiotic, may be prescribed to treat the very rare condition, Milia en plaque.
How do I prevent Milia?
Nothing will prevent milia from forming if you’re genetically prone to getting it, but there are things you can do to decrease the likelihood.
- Limit sun exposure. Wear sunscreen every day.
- Consider switching cosmetics and/or moisturizers.
- Wear an oil-free sunscreen and stay away from heavy skin and hair care products.
- Cleanse with a salicylic wash to remove surface debris and cleanse pores each morning. Use a retinoid/vitamin A product at night.
- Exfoliating and deep cleansing once or twice weekly can help speed up the process.
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The Information provided on our website is not medical advice and should not be viewed as such. By law, only a medical doctor can diagnose or give medical advice. As a registered nurse, my goal is to educate, so I provide information on skin care, skin care products, and skin care treatments. If you have any condition that concerns you, please see a medical doctor. While most skin conditions are benign, some - like melanoma - can be deadly. If there is any doubt, please, please consult your physician. Thank you!