Overview

Milia are tiny, white or yellowish bumps that appear on the skin's surface. They occur when keratin, a protein found in skin, hair, and nails, becomes trapped beneath the outer layer of the skin, forming a small cyst. Milia are very common in newborns (often called "milk spots"), but they can affect people of all ages, from children to adults and elderly individuals.

Thankfully, milia are not contagious, so you don't have to worry about them spreading from person to person. While they are generally harmless and don't cause pain, their appearance can sometimes be a source of concern or frustration, especially if they are numerous or in a noticeable spot. We understand that any change in your skin can be worrying, and we're here to help you understand what might be happening.

Symptoms

You or your child might be noticing a few distinct signs if you have milia:

• Small, pearly white or yellowish bumps - on the skin, usually 1-2 millimeters in size.
• Bumps most commonly appear - on the face, especially around the eyelids, cheeks, nose, and chin. In infants, they can also appear on the gums or roof of the mouth (called Epstein pearls).
• The bumps feel firm - to the touch.
• They are generally not itchy or painful. If you experience itching or pain, it might be something else.
• Milia can appear as a single bump or in clusters.
• The skin around the milia usually looks normal, without redness or swelling, unless the area has been irritated.
• They are not pimples - (comedones) and cannot be "popped" in the same way, as they don't have an opening to the skin surface. Trying to squeeze them can damage the skin.

Diagnosis

Diagnosing milia is usually straightforward for a healthcare professional.

• A doctor or dermatologist can often diagnose milia simply by looking at the skin. The characteristic appearance of these small, firm, white bumps is usually enough.
• In most cases, no special tests are needed. Very rarely, if the diagnosis is uncertain or the bumps look unusual, a doctor might consider a skin biopsy, but this is uncommon for typical milia.

It's always best to have any new skin growths checked by a professional to ensure an accurate diagnosis.

Management & Treatment

Dealing with milia can be a test of patience, but the good news is they are harmless and often go away on their own, especially in babies. For adults, if they persist and you find them bothersome, there are several gentle and effective ways to manage them.

The most important tip is to avoid picking or trying to squeeze the bumps yourself. Your skin is delicate, and trying to extract them at home can lead to irritation, scarring, or infection without successfully removing the milium.

Home Care and Over-the-Counter Options:

• Leave Them Be: Often, the best approach is to do nothing at all. Milia frequently clear up on their own over several weeks or months.
• Gentle Cleansing: Keep the area clean by washing your face with a mild, soap-free cleanser and patting it dry.
• Exfoliation: For adults, using a gentle exfoliating product containing salicylic acid, alpha-hydroxy acid (AHA), or a topical retinoid (like adapalene or retinol) can help. These products encourage skin cell turnover, which can help release the trapped keratin. Be very careful when applying these around the eye area.
• Sun Protection: Protecting your skin from the sun is always a good idea and may help with certain types of milia associated with sun damage.

When Professional Treatment Can Help: If milia are persistent and their appearance bothers you, a dermatologist can help. It’s important to see a professional for treatment, especially for milia around the delicate eye area.

• Extraction: A dermatologist can use a sterile needle or blade to create a tiny opening in the skin and gently push out the trapped keratin. This is a quick and effective procedure when done by a professional.
• Topical Retinoids: A doctor may prescribe a stronger retinoid cream than what is available over the counter to help exfoliate the skin.
• Other Procedures: In some cases, treatments like chemical peels, laser ablation, or cryotherapy (freezing) may be used to treat numerous milia.

Improvement can be immediate with professional extraction. If using topical treatments, it may take several weeks to months to see results as your skin goes through its natural cycle of renewal. If you’ve tried over-the-counter options for a few months without success, or if you're unsure what to do, it’s a good time to consult a healthcare professional.

Duration & Outlook

The timeline for milia can vary depending on age and type.

• In newborns, milia are very common and usually disappear on their own within a few weeks to a few months without any treatment. These are considered acute and self-resolving.
• In older children and adults, milia can sometimes be more persistent and may last for months or even years if not addressed. While some may resolve spontaneously, others might require professional removal if they are bothersome.
• The good news is that milia are benign (not harmful) and generally don't lead to long-term skin problems. They don't typically leave scars unless they are picked at or improperly removed.
• Warning signs for complications are rare with milia. However, if you notice a bump growing rapidly, changing color, bleeding, or becoming very inflamed, it's important to see a doctor, as this could indicate a different condition.

Prevention

Preventing milia entirely can be challenging, especially for primary milia that appear without a known cause.

• For newborns, milia are very common and generally cannot be prevented.
• For older individuals, some types of milia (secondary milia) can be linked to skin damage or certain products. Gentle skincare practices may help.
• Avoid using very heavy, oil-based creams or ointments - on milia-prone areas if you find they trigger your milia.
• Protect your skin from sun damage - by using sunscreen, as sun damage can sometimes contribute to milia formation over time.
• Be gentle with your skin; avoid harsh scrubbing or trauma, which can sometimes lead to secondary milia.

Causes & Triggers

Milia occur when keratin, a protein naturally found in your skin, gets trapped beneath the surface.

• The primary cause is the entrapment of dead skin cells and keratin - under the skin's surface, forming a tiny cyst. This can happen when the skin's natural exfoliation process doesn't work as efficiently.
• Common triggers for secondary milia - (milia that develop due to other factors) include:
  • Skin damage from burns, blistering injuries, or rashes like poison ivy.
  • Long-term use of topical steroid creams.
  • Dermabrasion or laser resurfacing procedures.
  • Prolonged sun exposure and sun damage.
  • Use of heavy, pore-clogging skincare products in some individuals.
• Who is most likely to develop it?
  • Newborn babies - are very prone to milia (often called "milk spots").
  • Individuals who have experienced skin trauma or burns.
  • People with certain skin conditions like blistering disorders (e.g., epidermolysis bullosa, porphyria cutanea tarda).
• Risk factors - include genetic predisposition in some rare syndromes, but for common milia, the main risk factors are being a newborn or having experienced the triggers mentioned above.

When to see a doctor

While milia are generally harmless, it's always a good idea to consult a healthcare professional if you have any concerns.

• See a doctor or dermatologist if you are unsure about the diagnosis - and want to confirm that the bumps are indeed milia and not something else.
• If the milia are widespread, numerous, or causing you significant cosmetic concern - or distress.
• If milia in an older child or adult are persistent - and don't go away on their own after several months.
• If a bump that you think is milia starts to change in size, shape, or color - or if it becomes red, inflamed, itchy, or painful.
• If you are considering removal, it's important to have this done by a professional to avoid scarring or infection. Please do not try to pick or squeeze milia yourself.

Frequently Asked Questions (FAQs):

• Q: Are milia a type of acne? A: No, milia are different from acne. Acne involves clogged pores with oil and bacteria, often leading to inflammation, blackheads, or whiteheads with an opening. Milia are tiny cysts filled with keratin and don't have an opening.
• Q: Can I pop milia like a pimple? A: It's strongly advised not to try and pop or squeeze milia. They are not like pimples and are harder to extract. Trying to do so can damage the surrounding skin, lead to inflammation, infection, or even scarring.
• Q: Do milia mean my baby's skin is dirty? A: Absolutely not! Milia in babies are incredibly common and are not a sign of poor hygiene. They are just a result of tiny skin flakes getting trapped.
• Q: Will milia leave scars? A: Milia themselves do not typically leave scars. Scarring can occur, however, if the milia are aggressively picked at, squeezed, or improperly removed.
• Q: If I have milia, will my children get them? A: Common milia are not directly inherited in a simple way. While newborns frequently get them, it's a result of their developing skin rather than direct inheritance of the condition in the way adult persistent milia might be considered. Some very rare genetic conditions can include milia as a symptom, but this is not the case for typical milia.