Medically reviewed by Dr Justine Hextall, Consultant Dermatologist on 27th September 2018.
They appear seemingly overnight, often in groups, stay for months on end and eventually disappear as mysteriously as they appeared. While they’re there these little white spots do nothing but annoy you. Worse still you don’t even know their name! The small lumps that appear around your eyes, cheeks and face are called milia. They are often mistaken for whiteheads, which can cause ill-advised attempts to scratch or squeeze them.
Treatments for Milia Removal
Most milia do not need to be treated; they are benign cysts that normally disappear within a few months. However, we understand that numerous milia on the face, particularly around the eyes, can make you feel self-conscious and make applying make-up more difficult. The best treatment for you will depend upon the type of milium you have, as well as the location and number that require removing.
The most common forms of milia removal are:
A dermatologist anaesthetises the area then uses a thin, sterile, medical-grade needle to prick each individual milium and gently squeeze out the little hard keratin bump. This treatment is the most common approach but it not suitable for all types of milia.
- Topical medications
A dermatologist may recommend applying a small dot of a medicated cream, such as the retinoid Tretinion, to the milia. This is an effective method for treating milia on areas of the face, such as the cheeks, and on the body but medicated creams should not be applied in the eye area.
- Skin peels
Skin peels using AHA (glycolic acid) or BHA (salicylic acid) can be used to treat milia as they remove the topmost layers of the skin. By mildly irritating the skin the chemical peel encourages the dead layers of skin to gently peel, exposing the fresh skin below. Thereby removing the milia and giving the face a healthy, rejuvenated appearance.
- Medical Microdermabrasion
Similar to skin peels, medical microdermabrasion removes the topmost layers of the affected skin by gently exfoliating the affected area with medical grade aluminium crystals. This gentle and effective treatment reveals the new skin below, giving a fresh, milia free appearance.
Our clients often tell us that they are tempted to treat milia at home either by squeezing the cyst or inserting a needle into it. We strongly recommend you ask a dermatologist to remove any unwanted milia to ensure extraction is performed in a sterile environment; extracting milia yourself can lead to infection, skin damage and scarring.
Causes and Types of Milia
WHAT ARE MILIA?
Milia, also known as milk spots, are small, hard, raised bumps approximately 1-2mm in diameter and appear pearly-white or yellowish in colour. They are located immediately below the epidermis, the very outer layer of skin, making their distinctive colouring so visible. They usually occur in a group which is why they are more frequently referred to in their plural form milia, rather than the singular term milium.
Milia are very common, benign, epidermoid cysts that are filled with a dead skin cells formed of a protein called keratin, which occurs naturally in the skin and can be found in nails and hair. Unlike a sebaceous cyst (also called an epidermal inclusion cyst), milia do not form from a pore; they are just a pocket of normal skin that somehow indented, sealed over and the dead cells got trapped. Once they emerge that rarely change in appearance and rarely become swollen or inflamed, but they may become itchy
Milia are very common, and are most often seen on the skin around the cheeks, nose, eyes and eyelids, forehead and chest. However, they can occur anywhere on the body. They are common in all ages, particularly in newborn babies, and affect both sexes. These frustrating yet benign bumps can last for weeks, months, or sometimes even longer.
Causes of milia
Doctors don't know why milia occur in adults: unlike some skin conditions they don't seem to be related to diet, lifestyle or health issues. They usually form spontaneously around the eyes, on the face and body
However several potential causal factors have been identified:
- Slow natural exfoliation: milia form when the skin’s natural exfoliation process malfunctions, as keratin becomes trapped beneath the surface of the skin by dead skin cells clumped together.
- Skin conditions, infections or injury: Trauma to the skin caused by conditions and infections, such as herpes, rashes and even burns can cause milia to form
- Sun Damage: very sun damaged skin can be rough and leathery in texture making it more difficult for dead cells to rise to the skin’s surface and shed normally. The resulting clogs can trigger milia formation.
- Allergic Reactions: allergic reactions and irritation caused by harsh skincare products can cause milia around the affected areas.
- Medications: Long term use of steroid creams can lead to milia on the skin where the cream is applied. However, such side effects from topical medications are rare.
- Rosacea: rosacea and facial dandruff (seborrheic dermatitis) are rashes that can cause milia to form.
- Illnesses and disorders: milia is associated with genetic or autoimmune skin disorders, such as discoid lupus or lichen planus, nevoid basal cell carcinoma syndrome, Gardner syndrome and Bazex-Duprè-Christol syndrome.
Types of milia
Experts have identified 5 types of milia:
- Neonatal milia.
Neonatal milia, often referred to as milk spots, develop in newborn babies. They are very common, with up to 50% of babies developing them, and are found around the nose area but may also occur on the scalp, cheeks, upper body and inside the mouth. They are thought to arise from sweat glands that aren't fully developed or mature. They are completely harmless and painless for the baby and usually clear up within a few weeks.
- Primary milia.
A common form of milia found in children and adults of both sexes. Primary milia are caused by keratin trapped beneath the surface of the skin, often around the eyelids and forehead, due to slower natural exfoliation. They are asymptomatic, though they may itch or become irritated if rubbed against, and will disappear without treatment, though they tend to last longer in adults than in children.
- Secondary milia.
Secondary milia are similar in appearance to primary millia, small white/yellow cysts approximately 1-2mm in diameter. The cysts develop in an area of skin, anywhere on the body, that has previously been damaged or injured. It can also develop after certain skin creams, such as topical steroids and penicillamine are used for a pro-longer period. Secondary milia is thought to develop as the skin heals due to the sweat glands becoming clogged in the affected area. It can occur in adults and children of all ages and both sexes.
- Milia en plaque.
Milia en plaque is an extremely rare form that is commonly associated with genetic or autoimmune skin disorders such as discoid lupus. The cysts can be several centimetres in diameter and are usually seen behind the ears, but can affect the eyelids, ears, cheeks, or jaw. They develop on a distinct raised and inflamed patch of skin called a plaque, unilaterally or bilaterally. The cause for milia en plaque is not fully understood but is primarily seen in middle-aged women, though it can occur in adults and children of all ages and both sexes.
- Multiple eruptive milia.
Multiple eruptive milia is an extremely rare form that appears in clusters, crops, or patches that develop over a period of time, ranging from a few weeks to a few months. The symptoms are itchy cysts that can appear on the face, upper arms, and upper half of the torso.
The Benefits of Milia Removal
The Benefits of milia removal
At The Harley Medical Group caring and ethical treatment is the central tenant of who we are, which is why we always stress that milia is harmless and does not need to be treated. Most milia, with the exception of some secondary milia, will naturally disappear over the course of weeks or months. However, as milia often appear in groups we understand that in can be deemed unsightly, and can greatly impact a person’s confidence.
There are numerous benefits in milia removal:
- Removes a source of irritation, while milia are asymptomatic they can itch
- Stop irritated and red skin caused by rough sheets or clothing
- Increased self confidence; milia around the eyes can be very noticeable and make people feel self-conscious about their appearance
- Easier application of make-up and cosmetics
- Removes the appearance of acne prone skn; milia be mistaken for whiteheads giving areas of the skin the appearance of suffering from acne.
Our dermatology experts
From the beginning aimed and succeeded in establishing The Harley Medical Group as a leader in the field of Laser & Skin Treatments and Dermatology, with clinics throughout the UK. Our fully qualified medical team are specially selected for their experience, expertise and approachability as well as their friendliness. This means our clients know that they are not meeting with sales people but trained experts, who have the time and the expertise to explain procedures in detail and answer all of your questions. In fact, we’re happy to say that our team is amongst the best.
We are committed to continually improving and refining our services, while researching the latest advances, thereby provide the highest standard of treatment that the medical profession can offer. Our dermatological treatments are performed in our own clinics, all of which are registered with The Care Quality Commission and the HIW in Cardiff. And following your meeting with our Dermatologist you will receive full aftercare instructions and will continue to receive any support you need.
FREQUENTLY ASKED QUESTIONS
Does milia need treating?
Milia is a benign cyst caused by the protein keratin being trapped beneath the top layer of the skin. Medically it is not necessary for milia to be treated, and over a period of a few weeks or months most usually go away. However, many people choose to treat these cysts if they cause discomfort or feelings of self-consciousness.
Can eye creams make milia worse?
Many people believe eye creams, foundations, eyeliner pencils, or creamy concealers applied around the eyes cause milia under the eyes. However this is deemed unlikely by most dermatologists as approximately 50% of babies also develop milia. If you are concerned that your skincare or beauty regime is causing milia we would recommend using alternative products to see if they improve and disappear.
If a gentle exfoliator is not part of your weekly skincare regimen we would recommend including it as one of the most common causes of milia is thought to be a slower natural exfoliation of dead skin cells.
How are milia diagnosed?
Simple milia cysts are usually easily diagnosed by their typical appearance and generally no investigations are needed. However, in a few cases, if the diagnosis is uncertain or if ‘milia en plaque’ are suspected, your dermatologist may suggest a skin biopsy. During a skin biopsy, a small piece of skin is removed so that it can be examined under a microscope.
How can I prevent milia?
Nothing absolutely prevents milia from forming if you’re prone to them. As they are caused by keratin being trapped beneath the top layer of the skin we recommend regular, gentle exfoliation; however we this must be done without irritating the skin. Also, some skincare products that create exfoliation like Retin A (tretinoin) and glycolic acid usually help reduce the size and number of milia. Regular facials and mild chemical peels often help. We generally recommend a combination of treatments and skincare products to prevent, reduce and remove milia.
If not milia, what else could it be?
There are other skin conditions that are similar in appearance to milia but are not related to the skin complaint, several of which require dermatological attention, including:
- Acne vulgaris - closed comedones are more cream than white, they usually have a small point Syringomas are small papules on lower eyelids and are skin-coloured
- Xanthelasma are yellow, flat plaques of cholesterol that can occur right alongside milia under the eyes
- Basal cell carcinoma is a form of skin cancer often caused by too much exposure to UV light
- Trichoepithelioma is an uncommon condition where single or multiple benign hair follicle tumours appear on the face after puberty
- Follicular (or alopecia) mucinosis is a skin disorder that presents similarly milia en plaque as it can present as erythematous plaques