Have you ever seen a slew of tiny and pesky white bumps on your face or other people’s? They’re tiny white bumps that appear on your nose, chin, cheeks, and other areas on your body that are painless even when you give them a squeeze. Nothing happens when your give them a squeeze — no pain, no pus, and no blood. 

You likely have milia, a skin condition that’s often mistaken for whiteheads. Also known as ‘milk spots’, milia are keratin-filled cysts that form just under the skin, looking like white or yellowish bumps on the surface. They are commonly associated with newborn babies, but occur in children and adults, too.

When you do see them, resist the urge to try removing them.

What causes milia in adults?

Milium (singular form of the word) happens when a plug of dead skin cells, called keratin, gets trapped beneath the skin’s surface and form small, hard cysts. Milia cysts occur more commonly among babies because their skin is still learning to exfoliate, or slough off dead skin cells, on its own. 

Milia can occur anywhere most especially on the face, commonly around the eyelids and cheeks. They can also appear on the genitals. The vast majority of milia cases can pop up for no apparent reason, despite having a clear skin.

Other times, it can be chalked up to:

• certain skin conditions like epidermolysis bullosa (eb), cicatricial pemphigoid, porphyria cutanea tarda (PCT), rosacea, dandruff, and rare genetic skin disorders like Gardner Syndrome 
• long-term use of steroid and other heavy creams applied around the eye area where the skin is much thinner than other areas of the face
• skin damage blistering injuries, such as poison ivy, burns, long-term sun damage
• skin resurfacing procedures, such as dermabrasion or laser resurfacing
• medications like topical corticosteroids and the chemotherapy drug 5-fluorouracil.
• loss of the skin’s natural ability to exfoliate as a result of aging

The cause of milia in newborns is unknown, and doesn’t cause inflammation or swelling unlike baby acne. Infants who have milia are usually born with it, 

What do milia look like?

Milia are small, round little bump-like cysts found under the skin. They look a bit like whiteheads but unlike acne are not surrounded by redness. They are usually 1 to 2 millimeters (mm) in size.

Milia are completely benign. You are likely to get them in multiples.

Types of milia

Milia types fall into primary or secondary categories.

• Primary milia – occur spontaneously and are formed directly from entrapped keratin. 
• Secondary milia – develop after the clearing of an inflammatory skin disease or skin trauma that clogs the ducts leading to the skin’s surface. This is also caused by contributing lifestyle factors including lack of sleep, smoking, poor personal hygiene, using oil-based beauty products in excess, and long-term steroid use. 

Here are the types of milia:

Neonatal milia

Neonatal milia are considered primary milia. They develop in newborns and clear within a few weeks. Cysts are typically seen on the nose, inside the mouth, scalp, and upper torso. 

Juvenile milia

Rare genetic disorders that affect the skin can lead to juvenile milia like nevoid basal cell carcinoma syndrome (NBCCS), pachyonychia congenital, Gardner’s syndrome, and Bazex-Dupré-Christol syndrome. 

Milia en plaque

This condition is commonly associated with genetic or autoimmune skin disorders like discoid lupus or lichen planus. The cysts can be several centimeters in diameter and are clumped together in a broad, flat patch raised above the surrounding skin.

Milia en plaque can affect children and adults, particularly middle-aged women. This patch or plaque often has a clear and defined border.

Multiple eruptive milia

This type of milia consists of numerous itchy bumps that can appear on the face, upper arms, and torso. They appear in the same area over several weeks or months. 

Traumatic milia

They are considered secondary milia. Traumatic milia occur where there is injury to the skin like severe burns, allergic reaction, excessive exposure to sunlight, and rashes. The cysts may become irritated, making them red along the edges and white in the center. 

Milia associated with drugs or products

The use of steroid creams and certain topical medications can lead to milia. If you have milia-prone skin, avoid ingredients like liquid paraffin, liquid petroleum, paraffin oil, paraffinum liquidum, petrolatum liquid, petroleum oil, and lanolin.

Diagnosis

Milia have a characteristic appearance. Your doctor will examine your skin to determine if you have milia based on the appearance of the cysts. On occasion, a skin biopsy may be performed.

How do you prevent Milia?

Can we prevent milia? The short answer is, sadly, not really. If you are prone to getting milia, there is no true way to permanently prevent them from forming. 

However, when milia are associated with other skin conditions or injuries, swift treatment may keep them from appearing.

Good skin care should be practiced; prevention, after all, is better than cure. Here are some of the skin care tips you can try:

1. Use high-protection sunscreen and avoid excessive exposure to the sun.
2. Avoid oil-based formulas and make-up removers around the eyes because they can leave an oily residue. Steer clear too of thick creams.
3. Exfoliate regularly as it works wonders in preventing milia. Look for AHA and BHA acid exfoliators, a “glycolic acid 5-10 %and a salicylic 2%”.
4. Choose correct eye care to avoid puffiness from fluid build-up. This usually happens with aesthetic interventions which limit muscle movements such as Botox and lymph circulation.
5. Remove your make-up thoroughly before bed, particularly if you wear heavy make-up and/or live in a polluted area.
6. Use topical retinoids. Retinol has vitamin A which assists skin cell turn over, allowing the milia to surface and preventing the build-up of dead cells leading to the cysts. Topical retinoids come in the form of creams or gel and will require a prescription.

Alternatively, you can also adopt lifestyle changes that can help prevent milia. Limit your intake of cholesterol-rich foods like meat, eggs, etc and incorporate vitamin D supplementation.

In-office treatment for milia

In most cases, milia will disappear on their own within a few months. If they persist and cause discomfort, there are treatments that can be effective in eliminating them.

They include: 

• Chemical peels – superficial peels containing AHAs and BHAs including glycolic and salicylic acid that provide accelerated, chemical exfoliation without the need to aggressively scrub your skin. They are non-abrasive and will only lift off the top layer of skin, ensuring the skin is ‘clean and fresh. Fewer dead cells = fewer bumps.
• Diathermy – uses extreme heat to destroy the cysts.
• Cryotherapy – is the most frequently used removal method.Liquid nitrogen freezes the milia. 
• Laser ablation – A small laser focuses on the affected areas to remove the cysts.
• Manual extractions – the best treatment for milia done by a professional at the dermatologist’s office. A tiny opening is made in the surface of the skin to remove the hard plug of material that makes up the milium. It is gently pushed out through the opening with the technician’s fingers or a tool called a comedone extractor. This procedure is sometimes called de-roofing.
• Destruction curettage – cysts are surgically scraped and cauterized.