Milia: Causes, Treatments, and How to Safely Remove Them

Introduction

Milia are small, white or yellowish bumps that often appear on the skin, particularly on the face. These tiny cysts form when keratin, a protein naturally found in the skin, becomes trapped beneath its surface. While milia are harmless and typically painless, they can be a cosmetic concern for many individuals. This common skin condition affects people of all ages, from newborns to adults. In dermatology, milia are recognized as a benign issue that often requires little to no medical intervention. However, understanding what milia are and how to manage them can help ease concerns and promote healthier skin.

This article provides a comprehensive guide to milia, including their risk factors, symptoms, diagnostic methods, treatment options, and home remedies. Whether you are encountering milia for the first time or seeking advice on managing recurring cases, this guide will equip you with the knowledge to make informed decisions about your skin health.

What Are Milia?

Milia are small, keratin-filled cysts that develop just beneath the skin’s surface. Their formation can be influenced by a variety of factors, including lifestyle habits, medical history, genetics, and age. This article will delve into the causes of milia, their risk factors, symptoms, diagnostic methods, and available treatments, as well as home remedies to help you effectively manage this common skin condition.

Description of Milia

Milia are tiny, dome-shaped bumps that form when dead skin cells or keratin become trapped beneath the skin’s outer layer. They most commonly appear on the face, particularly around the eyes, nose, and cheeks, but can also develop on other parts of the body. Milia are categorized into two main types: primary and secondary. Primary milia occur spontaneously, often in newborns, while secondary milia result from skin damage, such as burns, blisters, or prolonged sun exposure.

The progression of milia varies depending on age. In newborns, they often resolve naturally within a few weeks without any treatment. In adults, however, milia may persist longer and sometimes require medical or cosmetic intervention if they do not disappear on their own. Although milia are harmless, they are frequently mistaken for other skin conditions, such as acne or whiteheads, making accurate diagnosis essential.

Statistics show that milia are very common, affecting up to 50% of newborns and a significant number of adults. While they are neither contagious nor harmful, their appearance can cause concern for those affected. Gaining a better understanding of the nature and causes of milia can help reduce anxiety and guide appropriate treatment decisions.

Risk Factors for Developing Milia

Lifestyle Risk Factors

Certain lifestyle habits can increase the likelihood of developing milia. Prolonged sun exposure, for instance, can damage the skin and lead to secondary milia. Using heavy or oil-based skincare products that clog pores may also contribute to their formation. Additionally, improper skin care, such as infrequent exfoliation or the use of harsh cleansers, can cause dead skin cells to accumulate, raising the risk of milia. Smoking and exposure to environmental pollutants may further compromise skin health and increase susceptibility to this condition.

Medical Risk Factors

Specific medical conditions and treatments can heighten the risk of developing milia. Skin injuries, such as burns, blisters, or rashes, can lead to secondary milia as the skin heals. Certain medications, including topical steroids, may also contribute to their formation. Skin conditions like rosacea or eczema, which cause inflammation or damage, can make individuals more prone to milia. Additionally, cosmetic procedures such as laser treatments or chemical peels, if not performed correctly, can result in skin trauma and secondary milia.

Genetic and Age-Related Risk Factors

Genetics can play a significant role in the likelihood of developing milia. Some individuals may have a genetic predisposition to this condition, making them more prone to its occurrence. Age is another important factor. Newborns are particularly susceptible to primary milia, which often resolve naturally. In adults, the risk of milia may increase with age due to changes in skin texture and slower cell turnover. Older adults may also experience milia as a result of long-term sun damage or other age-related skin changes.

By understanding these risk factors, individuals can take proactive steps to minimize their chances of developing milia and seek appropriate care when necessary.

Clinical Manifestations of Milia

Small White Bumps

Small white bumps are the hallmark sign of milia, occurring in nearly all cases. These bumps, also known as “milium cysts,” are tiny, pearl-like lesions that form on the skin’s surface. They develop when keratin becomes trapped beneath the outermost layer of the skin. Milia are most commonly seen on the face, particularly around the eyes, nose, and cheeks. These bumps are painless and often mistaken for acne or whiteheads. However, unlike acne, they are not caused by clogged pores or bacteria. Milia can appear at any age but are especially prevalent in newborns, where they are referred to as “neonatal milia.”

Raised Lesions

Raised lesions are another common feature of milia, observed in the majority of cases. These lesions are slightly elevated above the skin’s surface and have a firm texture. They result from the accumulation of keratin within small cysts, creating a noticeable bump. Raised lesions are typically uniform in size and shape, distinguishing them from other dermatological conditions like acne or eczema. While they are most commonly found on the face, they can also appear on other areas of the body, such as the chest or back, particularly in adults with secondary milia.

Painless Nodules

Painless nodules are present in most cases of milia. These small, dome-shaped nodules do not cause discomfort or tenderness when touched. The absence of pain is a distinguishing feature of milia, setting them apart from other skin conditions like cystic acne or boils, which can be painful. The painless nature of these nodules is due to the lack of inflammation or infection in the cysts. They are purely cosmetic and do not pose any health risks.

Keratin-Filled Cysts

Keratin-filled cysts are the defining characteristic of milia, present in all cases. These cysts form when keratin becomes trapped beneath the epidermis, leading to the formation of small, hardened cysts that appear as white or yellowish bumps. Keratin-filled cysts are harmless and do not grow or change over time. While often mistaken for other skin conditions, their distinct appearance and lack of symptoms make them relatively easy to identify during a clinical examination.

Localized Skin Thickening

Localized skin thickening, also known as “plaques,” is observed in some cases of milia, particularly in patients with secondary milia. This occurs when multiple cysts cluster together, causing the skin in that area to appear slightly thicker or rougher. The thickening results from the accumulation of keratin beneath the skin and is more common in areas exposed to repeated trauma or irritation, such as the hands or feet. While less common, this manifestation can be more noticeable and may require specific treatment approaches.

No Inflammation

The absence of inflammation is a key feature of milia, present in nearly all cases. Unlike acne or other skin conditions that involve redness, swelling, or irritation, milia cysts are non-inflammatory. This lack of inflammation is due to the fact that the cysts are not caused by infection or immune system activity but by the mechanical trapping of keratin. The skin surrounding the cysts typically appears normal, helping differentiate milia from other dermatological conditions.

Skin Discoloration

Skin discoloration is a less common manifestation of milia, occurring in a small percentage of cases. When present, it usually appears as a slight yellow or white hue around the cysts. This discoloration is caused by the keratin content within the cysts, which reflects light differently than the surrounding skin. While not harmful, skin discoloration can be a cosmetic concern, particularly if the milia are located on highly visible areas such as the face.

Clustered Appearance

A clustered appearance of cysts is seen in many cases of milia, particularly in secondary milia. This occurs when multiple cysts form in close proximity, creating a grouped or “plaque-like” appearance. Clusters are more common in areas of the skin that have experienced trauma, burns, or prolonged sun exposure. The clustered nature of these cysts can make them more noticeable and may require targeted treatment to resolve.

Common on Face

Milia are most commonly found on the face, with the majority of cases involving this area. The cysts are particularly prevalent around the eyes, nose, and cheeks, where the skin is thinner and more prone to keratin entrapment. While milia can occur on other parts of the body, their concentration on the face makes them a frequent cosmetic concern. This distribution is consistent across all age groups, from newborns to adults.

Often Seen in Newborns

Neonatal milia occur in a significant percentage of newborns, making it a very common condition in this age group. These cysts typically appear within the first few weeks of life and are most commonly found on the nose, cheeks, and forehead. Neonatal milia are thought to result from the immaturity of the skin’s sweat glands, which can lead to keratin entrapment. Unlike adult milia, neonatal milia usually resolve on their own within a few weeks to months without the need for treatment.

Diagnostic Evaluation

How is Milia Diagnosed?

The diagnosis of milia is primarily clinical, meaning it is based on a healthcare provider’s careful examination of the skin. During the consultation, the provider will assess the affected areas, paying close attention to the size, shape, and distribution of the cysts. A detailed medical history may also be taken to rule out other conditions, such as acne, eczema, or other dermatological disorders. In most cases, no additional tests are necessary, as the distinctive appearance of milia is usually sufficient for diagnosis. However, in more complex or atypical cases, further diagnostic evaluations may be required to confirm the diagnosis or exclude other underlying conditions.

Skin Biopsy

Test Information: A skin biopsy involves removing a small sample of skin tissue for microscopic analysis. This procedure is performed under local anesthesia to minimize discomfort. The sample is then examined in a laboratory to identify keratin-filled cysts, which are the defining feature of milia. Although rarely needed, a biopsy may be recommended if the diagnosis is unclear or to rule out other conditions, such as sebaceous cysts or basal cell carcinoma.

Results that Indicate Milia: Biopsy results that reveal small, keratin-filled cysts confirm the presence of milia. If the findings do not align with milia, the provider may investigate other conditions with similar symptoms. For example, signs of inflammation or infection could point to acne or folliculitis. If symptoms persist despite negative biopsy results, additional evaluations may be necessary to uncover the underlying cause.

Dermatoscopy

Test Information: Dermatoscopy is a non-invasive diagnostic method that uses a dermatoscope, a specialized magnifying device, to examine the skin in greater detail. This tool allows healthcare providers to visualize the internal structure of cysts and evaluate their size, shape, and distribution. Dermatoscopy is particularly useful for distinguishing milia from other skin conditions that may look similar.

Results that Indicate Milia: Under dermatoscopy, milia appear as well-defined, white or yellowish structures with a smooth surface. The absence of inflammation, vascular patterns, or irregular pigmentation supports the diagnosis. If the findings are inconclusive, additional tests, such as a biopsy, may be suggested. In cases where no abnormalities are detected but symptoms persist, the provider may explore other potential causes or refer the patient to a dermatologist for further evaluation.

What if All Tests are Negative but Symptoms Persist?

If all diagnostic tests yield negative results but symptoms of milia continue, follow-up with a healthcare provider is crucial. They may recommend seeking a second opinion from a dermatologist or conducting further evaluations to rule out other conditions. Persistent symptoms could indicate an underlying issue that has not yet been identified. In the meantime, providers may discuss treatment options to manage symptoms and improve the skin’s appearance while continuing to monitor the condition.

Health Conditions with Similar Symptoms to Milia

Sebaceous Cysts

Sebaceous cysts are benign, closed sacs filled with a yellowish, oily substance called sebum. They form when sebaceous glands become blocked and are commonly found on the face, neck, or torso. These cysts can vary in size, ranging from small to relatively large.

How to Know if You Might Have Sebaceous Cysts vs. Milia: While both sebaceous cysts and milia can appear as small, raised bumps, there are key differences. Sebaceous cysts are typically larger, softer, and may have a central opening or dark spot, which milia lack. In contrast, milia are firm and white or yellowish. Sebaceous cysts may feel rubbery or fluid-filled, whereas milia are solid. A healthcare provider can differentiate between the two through a physical exam, and in some cases, imaging tests or a biopsy may be used to confirm the diagnosis.

Acne

Acne develops when hair follicles become clogged with oil and dead skin cells, leading to blemishes such as whiteheads, blackheads, pimples, or cystic lesions. It commonly appears on the face, chest, back, and shoulders.

How to Know if You Might Have Acne vs. Milia: Although acne and milia can both present as small bumps, acne is often accompanied by redness, inflammation, and sometimes pain. Acne lesions may also contain pus, whereas milia are firm, painless, and lack inflammation. A dermatologist can distinguish between the two by examining the skin. Acne typically responds to treatments like topical retinoids or benzoyl peroxide, which are ineffective for milia. Additionally, acne may leave scars or dark spots, while milia do not.

Follicular Keratosis

Follicular keratosis, also known as keratosis pilaris, is a harmless condition that causes small, rough bumps on the skin, often on the upper arms, thighs, or cheeks. These bumps result from a buildup of keratin in hair follicles.

How to Know if You Might Have Follicular Keratosis vs. Milia: While both follicular keratosis and milia can appear as small, raised bumps, follicular keratosis is typically rough to the touch and may appear red or inflamed. In contrast, milia are smooth, firm, and white or yellowish. A healthcare provider can diagnose follicular keratosis through a physical exam, noting its rough texture and common locations, which differ from the facial distribution of milia.

Epidermoid Cysts

Epidermoid cysts are small, slow-growing, benign lumps beneath the skin that are filled with keratin. They often develop on the face, neck, or trunk and may become inflamed or infected.

How to Know if You Might Have Epidermoid Cysts vs. Milia: Both epidermoid cysts and milia can appear as small, raised bumps, but there are notable differences. Epidermoid cysts are usually larger, softer, and may have a visible pore or opening, unlike milia, which are smaller, firmer, and lack an opening. A healthcare provider may use a physical exam or biopsy to differentiate between the two. Epidermoid cysts may require surgical removal, while milia often resolve on their own or with minor dermatological procedures.

Keratosis Pilaris

Keratosis pilaris is a common, harmless condition characterized by tiny, rough bumps, often referred to as “chicken skin.” These bumps typically appear on the upper arms, thighs, cheeks, or buttocks due to keratin buildup in hair follicles.

How to Know if You Might Have Keratosis Pilaris vs. Milia: While keratosis pilaris and milia can both present as small bumps, keratosis pilaris is rough and may appear red or inflamed. In contrast, milia are smooth, firm, and white or yellowish. A healthcare provider can distinguish between the two through a physical exam, noting the rough texture and common locations of keratosis pilaris compared to the facial distribution of milia.

Treatment Options for Milia

Medications for Milia Removal

Topical Retinoids:

Topical retinoids, derived from vitamin A, encourage skin cell turnover, helping to shed dead skin cells and prevent clogged pores. They are commonly used to treat milia and other keratin-filled cysts.

Typically applied once daily in the evening, topical retinoids are often the first-line treatment for multiple or persistent milia. Consistent use over several weeks or months is necessary to see noticeable results.

Chemical Peels:

Chemical peels involve applying a chemical solution to exfoliate the outer layers of the skin, removing dead cells and unclogging pores. This treatment is particularly effective for widespread or stubborn milia that do not respond to topical therapies.

Performed by a dermatologist, chemical peels can result in smoother skin and a reduction in milia within weeks. Mild peels may also be recommended for ongoing maintenance.

Cryotherapy:

Cryotherapy uses extreme cold, often in the form of liquid nitrogen, to freeze and eliminate milia. This procedure targets the keratin-filled cysts responsible for the condition.

Typically reserved for advanced or treatment-resistant cases, cryotherapy is performed in a clinical setting. Healing usually occurs within days to weeks, with a visible reduction in milia.

Laser Therapy:

Laser therapy utilizes focused light energy to target and remove milia by creating tiny openings in the skin, allowing trapped keratin to be released.

This procedure is recommended for stubborn or recurring milia and is performed by a dermatologist, often with local anesthesia. Results are frequently immediate, with full healing occurring within a few weeks.

Dermabrasion:

Dermabrasion is a minimally invasive procedure that uses a rotating instrument to exfoliate the outer layers of the skin, removing milia and promoting a smoother complexion.

Performed in a dermatologist’s office, this treatment is suitable for widespread or persistent cases and may be combined with other therapies. Results typically become noticeable within weeks, with continued improvement as the skin heals.

Salicylic Acid:

Salicylic acid, a beta hydroxy acid, exfoliates the skin and helps unclog pores. Found in many over-the-counter skincare products, it is often a first-line treatment for mild cases of milia.

Available in creams, gels, or cleansers, salicylic acid can gradually reduce milia with regular use over several weeks.

Tretinoin:

Tretinoin, a prescription-strength retinoid, accelerates skin cell turnover, helping to prevent the formation of milia. Applied once daily, usually in the evening, it is recommended for persistent or widespread cases that do not respond to over-the-counter treatments.

Consistent use typically leads to improvement within weeks to months.

Benzoyl Peroxide:

Benzoyl peroxide, an antibacterial agent, reduces inflammation and unclogs pores. While primarily used to treat acne, it can also be effective for milia.

Available in gels and creams, benzoyl peroxide is often combined with other treatments. Regular use may result in a reduction of milia within weeks.

Corticosteroids:

Corticosteroids, which are anti-inflammatory medications, can help reduce swelling and redness associated with milia. They are typically prescribed for cases involving inflammation.

Applied topically, corticosteroids are not a first-line treatment but may be used in specific situations. Improvement is often noticeable within days.

In-Office Procedures for Milia Removal

Several in-office procedures are effective for treating milia, including:

1. Manual Extraction: A dermatologist uses a sterile tool to carefully remove milia.
2. Electrocautery: Heat is applied to destroy the cysts.
3. Microneedling: Tiny needles create micro-injuries in the skin to promote healing and reduce milia.

These procedures are typically reserved for stubborn or widespread cases and are performed by a dermatologist to ensure safety and effectiveness.

Expected Outcomes of Milia Treatment

The results of milia treatment vary depending on the severity of the condition and the patient’s skin type. Some treatments provide immediate results, while others require consistent use over weeks or months. Consulting a healthcare provider is essential to determine the most effective treatment plan for your specific needs.

Improving Milia and When to Seek Medical Help

In addition to medical treatments, several home remedies can help improve milia and prevent new lesions:

1. Exfoliation: Regular exfoliation removes dead skin cells and helps prevent clogged pores.
2. Steam Treatment: Steaming the face opens pores, making it easier to remove milia.
3. Gentle Cleansing: Using a mild cleanser helps maintain healthy skin without causing irritation.
4. Moisturizing: Keeping the skin hydrated reduces dryness and irritation.
5. Avoiding Heavy Creams: Heavy creams can clog pores and worsen milia.
6. Using Non-Comedogenic Products: These products are specifically formulated to avoid clogging pores.
7. Regular Facial Cleansing: Washing your face twice daily removes dirt and oil buildup.
8. Sun Protection: Sunscreen prevents skin damage and reduces the risk of milia.
9. Using Retinoids: Over-the-counter retinoids can improve skin cell turnover and reduce milia.
10. Applying Tea Tree Oil: This natural remedy has antibacterial properties that may help reduce milia.

While home remedies can be effective for mild cases, medical attention is necessary if milia persist, worsen, or cause discomfort. Telemedicine offers a convenient way to consult a healthcare provider, especially for those with busy schedules or limited access to dermatology services.

Living with Milia: Tips for Better Quality of Life

Living with milia can be challenging, particularly if it affects your confidence or self-esteem. Here are some tips to help improve your quality of life:

1. Adopt a consistent skincare routine that includes gentle cleansing and regular exfoliation.
2. Choose non-comedogenic, fragrance-free products to minimize irritation.
3. Protect your skin by using a broad-spectrum sunscreen with SPF 30 or higher.
4. Stay hydrated and maintain a balanced diet to support overall skin health.
5. Consult a healthcare provider for a personalized treatment plan tailored to your needs.

Milia are common and treatable. With the right approach, you can achieve clearer, healthier skin and regain confidence in your appearance.

Conclusion

Milia are small, white cysts caused by trapped keratin beneath the skin. While they are harmless, they can be frustrating to deal with. Early diagnosis and treatment are key to effective management.

If you’re struggling with milia, our primary care telemedicine practice is here to help. We offer convenient, compassionate care from the comfort of your home. Schedule a consultation today to take the first step toward healthier, clearer skin.

James Kingsley

Learn More