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.
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