The surface of our skin can often form an interesting landscape made up of bumps, ridges, scars, pores, and everything in between. Today, we’re jumping into one type of bump that you may have heard about most commonly in infants — milia.
Milia is a common skin condition that causes small white bumps (cysts) under the surface of your skin. About 40% to 50% of U.S. newborns have milia. Adults can get milia too. Treatment isn’t necessary because milia are harmless and go away on their own. The condition usually only lasts a few weeks.
What are Milia?
A milium cyst is a small, white bump that typically appears on the nose and cheeks. These cysts are often found in groups. Multiple cysts are called milia. Milia occur when keratin becomes trapped beneath the surface of the skin. Keratin is a strong protein that’s typically found in skin tissues, hair, and nail cells. Milia can occur in people of all ethnicities or ages. However, they’re most common in newborns.
Put simply, milia are small, hard bumps that form when dead skin cells get trapped in small pockets at the surface of your skin. They’re also known as “milk spots” or “oil seeds.” These dead cells are made up of keratin, the protein found on many surfaces across your body, including your skin, hair, and the lining of your organs.
Dead skin cells will normally fall off as part of your skin’s natural renewal process. However, when those skin cells don’t fall off, they can remain in place and harden, forming the small white or whitish cysts on your skin that are indicative of milia.
While you may choose to have milia removed for aesthetic reasons, this skin condition is harmless and does not require treatment.
Keep reading to learn more about milia, their causes, and what you can do to treat them.
What Are the Different Types of Milia Acne?
Milia comes in a variety of forms, differentiated by a number of factors, including the stage of life they occur in and their root cause. Here are the different types of milia and their causes
Neonatal Milia
Neonatal milia is the most commonly occurring form of milia, occurring in 40 percent to 50 percent of newborns. Newborn skin is still building up its exfoliating properties, which is what makes this condition so popular in babies. It usually goes away within a few weeks of birth.
Primary Milia
Primary milia is one of the two main categories of milia that occurs in adults. Primary milia is similar to the type seen in newborns and refers to milia that forms on its own, without any trauma to the skin. It will usually clear on its own within a few months.
Secondary Milia
Secondary milia occurs as a result of skin damage, appearing as the skin heals from its injury. It can be the result of a number of occurrences including sun damage, burns, friction, blisters, rashes, and topical medications.
Juvenile Milia
This type of milia will sometimes show up in newborns, but can also show up later in life. It is often linked to an inherited disorder.
Milia en Plaque
Milia en plaque is a rare form of primary milia that usually develops in people between 40 and 70 years old, presenting as clustered milia bumps. It is particularly prevalent in women.
Multiple Eruptive Milia
Another rare form of milia, this condition presents as groups of milia that are more numerous than what would normally be expected with primary milia. These groups normally appear suddenly, usually on the face, arms, or abdomen, and can sometimes be irritated.
Symptoms and Causes
What are the symptoms of milia?
Symptoms of milia include:
- White to yellow bumps (cysts) on your skin.
- Bumps can appear in groups or clusters.
- Bumps are asymptomatic and don’t cause pain or discomfort.
Depending on the type of milia, some can be itchy or form on a raised patch of skin.
Where will I have symptoms of milia?
Milia affects the skin on your body. They’re often located on your face. The most common places to find milia on your body include:
- On your eyelid or under your eyes.
- Cheeks.
- Forehead.
- Nose.
- Arms or legs.
- Genitals such as your penis.
- Inside of your mouth.
- Chest.
What causes milia?
Trapped dead skin cells that form cysts below the surface of your skin cause milia. Your body naturally gets rid of dead skin cells by shedding them to make room for new cells to grow and take their place. When your old skin cells don’t fall off of your body, new skin grows on top of them and traps them underneath. Your dead skin cells harden and turn into cysts.
Additional causes of milia include:
- Damage to your skin from an injury or sun exposure.
- Long-term use of steroid creams or ointments.
- A symptom of a genetic condition.
- An autoimmune response.
How Is Milia Diagnosed?
To figure out if those small bumps on your skin are, in fact, milia, you’ll want to consult with your dermatology provider. In most cases, they’ll be able to diagnose your milia visually. However, if your condition is unclear, they can also perform a biopsy to further analyze a sample of your skin under a microscope.
Milia vs. Acne
It’s important to know that while milia is often confused for baby acne in infants, it is not a true form of acne. Therefore, you should never try to remove milia yourself by squeezing at or attempting to pop the cyst out from your skin. While you should never pop your acne, its formation in your pores may allow you to manipulate your skin in order to remove the blockage.
Unlike acne, milia forms under the surface of your skin, as opposed to in your pores. So, there’s no natural outlet to squeeze anything out of. Attempting to remove milia on your own can only result in damage to your skin, which can lead to scarring.
What Are the Treatment Options for Milia?
Milia don’t need treatment because they’re not harmful. If you don’t like how milia look on your skin, talk to your healthcare provider about removing them. Treatment to remove milia could include:
- Application of over-the-counter adapalene gel or prescription tretinoin cream.
- Surgically removing the milia in your healthcare provider’s office by using a needle to puncture the milia and squeezing out the contents.
- Cryotherapy to freeze the milia on your skin to remove them.
- Using medicated creams or the antibiotic minocycline to treat milia en plaque.
Since milia is due to a lack of proper turnover in your skin cells, a gentle face exfoliant can help encourage skin turnover. This can be an exfoliant that works mechanically by scrubbing at your skin, or a chemical peel or retinoid that encourages peeling of your skin.
Before starting any at-home treatment, you’ll want to consult with your dermatology provider to ensure that your chosen method is right for your skin. If you choose to have milia removed by your medical provider for aesthetic reasons, there are a few options, including cryotherapy (where the cysts are frozen off), chemical peels, skin resurfacing treatments, laser surgery, heat therapy, and topical or oral medications.
How Can I Prevent Milia?
Your best option for preventing milia is a healthy skin care routine. The following tips are best practices for maintaining healthy skin, whether you’re actively managing milia or not:
- Protect your skin from exposure to sunlight. Use a sunblock that is at least 30 SPF daily. This will protect your skin from sun damage and slow the signs of aging.
- Wash your face twice a day. Washing your face in the morning and before bed (and moisturizing afterward) will help keep your skin clean and encourage healthy skin turnover.
- Exfoliate your skin. You’ll want to consult your dermatology provider on this one, but using an exfoliant two to three times per week can help your skin get rid of those pesky dead cells and deter milia from forming in the first place.
- Keep your skin hydrated. Hydration is essential not just for healthy skin, but for preventing various skin conditions. To learn more about maintaining long-lasting skin hydration, check out our guide on How to Hydrate Skin: 9 Expert Tips for Lasting Hydration.
How long do milia last?
In babies, milia usually last for a few weeks after they’re born. Adults can have milia for a few weeks to a couple of months before they clear up on their own. If you prefer to get rid of milia faster, talk to your healthcare provider.
Can I remove milia at home?
You shouldn’t try to squeeze or scrape off milia on your own, as you might do with a pimple. This can scar your skin or cause an infection. There are things you can do at home that can help:
- Wash your face every day with warm water and gentle soap. Then dry your skin very gently. Pat your skin dry.
- Don’t use lotions or oils that are meant for adults on a baby. Infant skin is too delicate.
- Adults might try an over-the-counter treatment to exfoliate their skin.
- Use sunscreen when you go outdoors.
Milia Removal
It’s OK to let milia run their course. They’ll go away on their own after a few weeks or months. You may be tempted to pick at or pop the milia. This irritation may only make it worse and cause complications. Picking at the skin around the milia can lead to scarring or an infection.
If you’re worried about how milia look, you can take a few steps to help the treatment process.
Milia treatment cream
There are a few over-the-counter gel options, including adapalene gel. Your doctor may also prescribe tretinoin cream or minocycline.
Milia treatment at home
Baby skin is too delicate for lotions, oils, or other cosmetics. Wash your baby’s face with warm water and, if needed, a mild baby soap daily and then pat the skin dry. Wait for the milia to clear. For adults, washing your face two times a day is recommended.
Exfoliation
An over-the-counter exfoliating cosmetic with salicylic acid, alpha-hydroxy acid, or a retinoid can help remove the dead skin cells. If the milia on your skin don’t clear up on their own or with the help of over-the-counter exfoliation treatment, your doctor can find a treatment plan. These treatments should only be used on adults, not children.
Removal at your doctor’s office
A dermatologist can do a simple procedure to surgically remove the milia. Some possible removal methods include:
- Freezing the milia
- Laser surgery
- Extreme heat
- Dermabrasion
- Oral medication
The Bottom Line on Milia Acne
Milia are small white bumps that can appear on your skin. They happen when dead skin cells that are supposed to fall off instead get trapped under the surface of your skin. Milia is a harmless condition that occurs when your dead skin doesn’t fall off, creating hard cysts under the surface of your skin. Milia are harmless but can be prevented by practicing good skin care routines like washing twice daily and exfoliating.
They can’t be prevented in infants. Milia should go away on their own within a few weeks; if they don’t, talk to your doctor about treatment options. You can choose to treat it for aesthetic purposes, or allow it to run its course. Maintaining a healthy skin routine is your best bet for the prevention of milia, but if it does occur, your dermatology provider can help you come up with a plan for removal and prevention.
What do milia look like?
Milia are usually very small, white or flesh-coloured bumps which are firm to the touch. They have a different appearance to a pimple or spot as they don’t have a head and cannot be squeezed. They are generally not red or inflamed (except for milia en plaque) and should not feel uncomfortable or painful. They usually appear on the skin around the eyes in groups, but it is possible to have just one milium at a time and they can occur on any part of the body, including the groin and genital area.
Are milia contagious?
Milia are not contagious so cannot be spread from person to person.
Are milia genetic?
There is no known genetic link with milia and the condition is not thought to be hereditary.
Can I remove milia myself?
Removing milia yourself is not recommended. To avoid infection, the treatment should be carried out in a safe clinical environment with sterile equipment. Trying to squeeze or pick at milia can cause the area to become inflamed, bruised or infected because they do not ‘pop’ in the same way as a pimple or whitehead.
How can I reduce the white spots under my eyes?
Ensuring you have a good skincare routine can help reduce white spots under your eyes, which should involve good quality products, regular exfoliation and wearing high factor sun protection.
Can skincare products cause or worsen white spots under the eyes?
If you do have Milia particularly around the eye area, it could be something to do with the skincare products you are using. The skin around the eye is much thinner than on the face, so when eye creams are thick and heavy they can block pore and trap dead skin cells. So make sure you invest in a good quality, light eye cream. Another cause could be sun damage or an allergic reaction to harsh facial products.