Milia 101: Removing those unsightly facial blemishes

An up close image of a man with milia on his left cheek.

What are those unsightly white bumps on my face?

    Many people think they're pimples. But they are not! Others think they're whiteheads. But they aren't that either! Those disagreeable-looking white, round things are milia.

Also called milium cysts, milk spots, oilseeds, or pearl acne, no matter what you call them, milia are decidedly unattractive, small or moderate-sized, round or dome-shaped, white or yellow bumps that are easily visible beneath the skin.

They can originate as tiny spots and get progressively larger, or can already be fairly sizeable when they first come to attention. In any event, regardless of their size and shape, most people are not happy to have them.

    Our skin is the largest organ of the body and while few people think of it in these terms, every moment of every day our skin is busy acting as a barrier between our internal organs and the outside world.

A remarkable fact about skin is that it routinely renews itself. Dead cells rise and fall away, to be replaced by fresh, new cells. In fact, every hour adults lose 30,000-40,000 dead skin cells and about a million of them are gone in a 24 hour period. Interesting, you may think, but what does all this have to do with milia? Actually quite a bit!

What can cause milia?

    It is possible for milia to occur on various parts of the body but they almost always appear on or around the face.

They can be caused by a number of things, such as:

Injury or damage to the skin from things such as a blistering rash like poison ivy, severe blistering burns, and sun poisoning or over-exposure to the damaging rays of the sun.

Whether you already have milia on your skin or not, thick oils and creams, certain types of mineral oil and lanolin in make-up or some skincare products, and particularly harsh facial and body scrubs may put you at higher risk to develop new milia or additional ones if you already have them.

Pre-existing conditions such as eczema, rosacea, and seborrheic dermatitis (facial "dandruff") may also encourage the formation of milia. 

However, in adults, the primary and by far the most frequent cause of milia is the failure of microscopic dead skin cells which have been shed normally, but for whatever reason are not rubbed, washed, or otherwise removed from the skin. These dead cells have nowhere to go and so they collect, forming a hardened ball that looks like a tiny pearl, unattractively obvious under the new skin that has formed over it, hence the name "pearl acne".

But names can be misleading and white pearls, tiny or otherwise, are generally attractive and desirable, milia "pearls" are certainly not.

They can occur in people of any age, from newborn to octogenarian and then some, and while they can make their home anywhere there is skin, they are almost exclusively seen around the eyes, nose, chin, cheeks, and even behind the ears. They occasionally emerge as a single entity but are much more often grouped in clusters of the same or varying size.

Are milia dangerous?

For all their disagreeable appearance, it is important to note that milia are harmless. They generally do not hurt or itch, and typically do not cause problems unless they are poked, prodded, squeezed, or otherwise manipulated in an effort to remove them at home. While it is possible for milia to disappear on their own, in adults they very rarely do, and most of the time, once adult skin is prone to forming milia, it continues to do so. In adults, milia often become permanent unless professionally removed, which is generally done for cosmetic reasons.

How can I remove milia?

    A word of warning here: Please do not try to remove milia yourself! The white you see is not something you can or should squeeze out as you might do with a standard pimple, and squeezing or picking at a milia cyst is not at all likely to remove it and may instead create irritation, bruising, discoloration, scarring, or other such unwanted circumstances which may or may not have the potential to become long-term.

There are a number of topical over-the-counter home remedies to reduce the size or eliminate milia, however, none are likely to work as safely, quickly, long-term/permanently, or as well as removal by a physician, and some home remedies may have the potential to worsen things.

Milia are generally very tightly stuck beneath the skin and it is not advisable for patients to scratch or dig at the area in an attempt at removal. While some people advocate lifestyle changes such as limiting high cholesterol foods like cheese, richly marbled meats, and eggs, or taking Vitamin D supplements to help prevent the formation of milia, experts believe that there is not enough actual science to confirm, duplicate, or verify these claims, and the results of these products may often fall short of patient expectations.

Do I need to see a dermatologist for my milia?

    We know that in adults milia do not usually resolve on their own and that the single simplest, safest, and most effective method of removal on the face or body is done by a Board-certified dermatologist. When they appear directly on the upper or lower eyelid, at the inner or outer corners of the eye, or at the very margins of the eye, milia can and often should be removed by a Board-certified ophthalmologist. Here at SINY Dermatology, we can diagnose and treat your general facial and body milia in a number of ways. A biopsy is rarely if ever needed, and our simple, in-office technique generally provides painless, long-term/permanent, positive results.

Let SINY Dermatology help you with milia!

    Please come in and see our team of Board-certified SINY Dermatologists. We are located at 56850 Main Road, Southold, New York, 11971. You can call us at 800-778-3090, or schedule an appointment at any one of our offices online. All of our locations are clean, comfortable, secure, and sanitary. Your comfort and satisfaction are our main concerns. Our staff is cooperative, welcoming, and waiting to assist you with milia or any other dermatologic concerns.

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