Overview

Milia, sometimes referred to as milk spots, are small white cysts typically noticeable on the skin of the face or neck. Milia are commonly found in people of all ages, and form when keratin (a substance naturally produced by the skin) is trapped under the outer skin layer. Although commonly confused with whiteheads, milia are harmless and only affect the appearance of the skin. Whiteheads are a form of acne, whereas milia are not.¹ 

This article will outline the impact that milia have on the health and appearance of the skin. 

What is milia?

Milia are small, white cysts on the skin, commonly found on the face. They are completely harmless and only impact the appearance of the skin. They are very common in babies but can affect anyone of any age, ethnicity or gender. They are typically found in clusters around the eyes, nose, cheeks and forehead.¹ 

There are a few different types of milia:

• Neonatal milia - This form is present at birth and affects infants, most often on or around the nose area. 
• Juvenile milia - These can be present at birth or develop later in life and are typically a symptom of an inherited condition.
• Primary milia  - Primary milia affects both children and adults, and is common on the eyelids, forehead, cheeks, or genitals in some cases.
• Secondary milia - Secondary milia occurs following damage to the skin, typically burns, rashes, or heavy sunlight exposure. They can also develop following a reaction to a type of skin cream. 
• Milia en plaque (MEP) - This is a rare type of milia affecting women between the ages of 40 and 60. They are visible usually in areas such as on the eyelids, cheeks, jaw, or behind the ears. 
• Multiple eruptive milia (MEM) - A rare form of itchy milia that causes groups of milia cysts to form over weeks on the face, upper arms, or upper abdomen.¹ 

What causes milia? 

Milia is primarily caused by trapped dead skin cells which accumulate to form harmless cysts under the skin. Although the exact reasons for this are not fully understood, various risk factors can lead to the formation of milia. This includes the following:

• long-term damage to the skin from an injury or skin exposure; 
• as a symptom of a genetic condition; 
• as a symptom of an autoimmune disease; 
• prolonged use of steroid creams or thick ointments. 

Milia are not restricted to one skin type either, anyone with dry, combination, sensitive, or oily skin can develop milia.²

Symptoms and Identification 

Milia typically appear as tiny (around 1-2mm) white, round cysts that are completely harmless. They are most common in areas such as the cheeks, eyelids, forehead, nose and chin. They can sometimes be found around the genital area depending on the type.

In adults, milia can last from anywhere between a few weeks to years. Although completely benign and harmless, some do find their appearance troubling and wish to remove them.³ 

Impact of milia on the skin 

The small white cysts are completely benign and superficial. They can sometimes be confused for whiteheads, which are a type of acne, but milia are not acne and so do not cause any physical discomfort or pain.

Although completely benign and harmless, some do find their appearance troubling and wish to remove them. Milia does not typically require treatment as it usually goes away on its own. If you do wish to remove milia, contact your healthcare provider and discuss the options with them. Do not attempt any at-home invasive treatments.³ 

Psychological impact 

The appearance of milia can be troubling for some individuals, so even though they do not pose any physical risk, they can cause some self-consciousness. 

Stress caused by one’s physical appearance is not uncommon and can sometimes lead to the development of a dermatological condition. Stress can cause an increase in the hormone cortisol, which in turn causes the skin to produce more of an oily substance called sebum, which can result in the formation of more acne and milia.³ 

Treatment and management

As milia pose no threat and are completely superficial, they do not typically require treatment. They have been known to disappear on their own without any intervention after a few weeks or months. However, if it is something that is causing emotional distress, it is possible to treat them. Always contact a healthcare professional if you are concerned about any cysts.³

Non-invasive treatment methods 

Depending on the severity of the milia, healthcare providers can recommend some alterations to your skincare routine. Exfoliating regularly with exfoliation products and thoroughly washing your face before bed can aid in both removing any existing milia as well as preventing them from appearing in the future.

Use the exfoliator at least once or twice a week for optimum results, and always wash your face by massaging the soap into clean damp skin in gentle circular motions and then rinsing with clean lukewarm water. There are many at-home recipes for scrub-like exfoliators which include sugar mixed with a natural oil, such as coconut oil.  Take care not to scrub the skin too vigorously as you can damage the skin.² 

Medical treatments

For those who want to remove the milia professionally, the healthcare provider may treat the milia with one of the following treatment options:

• Piercing each milium with a sterile scalpel or blade, then removing the built-up keratin with a comedone extractor. 
• Retinoid creams such as adapalene, tretinoin or tazarotene. 
• A treatment scheme of acid peels or microdermabrasion at the healthcare provider's office.⁴  

Preventative methods

Although the exact cause of milia is unknown, there are things you can do to reduce your chances of developing milia. 

If you spend a lot of time in the sun, ensure you wear a hat, sun cream and other protective items. This is because sun damage is known to cause secondary milia as the skin becomes too dehydrated for the dead skin cells to completely shed.

You can also help prevent milia by keeping a good skincare routine, as milia can form due to clogged pores. Hence, keeping the skin clean and hydrated will help prevent this. It is also important to not use too many thick creams, particularly around the eye region, as this can also lead to the development of milia. To ensure the best results, consult a dermatologist to recommend the best creams and products. You can also keep your skin clean by washing it twice a day and exfoliating one to two times a week.⁵

Summary

Milia are small harmless white cysts that occur due to the build-up of keratin under the skin. They are very common in infants but can affect anyone of any age, gender or ethnicity. Miliado not typically require any form of treatment, however they do affect the smoothness of the appearance of the skin, so some people choose to undergo treatment to remove them. Treatments such as chemical peels and extraction are available after consultation with a healthcare provider, however in most cases milia will disappear on their own after a few weeks or months. You can prevent the likelihood of developing milia by maintaining a good skincare routine, protecting against excessive sun exposure and exfoliating your skin one to two times a week. 

FAQs

What is the difference between milia and whiteheads?

Milia are often misconceived to be whiteheads but they are not the same thing. Whiteheads are a form of acne whereas milia are not. Acne is classified as inflammation of the skin’s hair follicle, whereas milia are cysts formed by trapped keratin under the skin.

Are milia contagious?

No, milia are not contagious, so cannot be passed from person to person. 

Are milia genetic?

There is currently no known genetic link to the development of milia, so the condition is not thought to be hereditary. 

What do milia look like?

Milia are usually very small, white or yellowish cysts which are firm when touched. They may appear similar to whiteheads, but are not the same so do not cause any pain or discomfort. They are most common around the eyes in groups, but can also be found on the cheeks, around the nose and jaw, and on the upper arms and chest. 

Can I remove milia myself?

No, it is not recommended to remove milia yourself in any invasive method. To avoid scarring and infections it is recommended that all procedures are done by a qualified healthcare provider using sterile equipment in a clinical environment. Trying to remove the milia yourself by squeezing the area can result in the area becoming inflamed, bruised or infected. 

You can, however, maintain a healthy skincare routine by washing your face twice a day and exfoliating regularly to avoid the dead skin cells building up, resulting in milia. You can also help prevent milia by using skin protection, such as sun creams, and avoiding using heavy creams around the eyes.

Can some skincare products cause or make milia worse?

If milia is most common for you around the eyes, it's possible your skincare products could be worsening the condition. The skin around the eyes is much thinner than the rest of the face, so thick heavy creams can block the pores, trapping the dead skin cells. Make sure any products used around the eyes are light and do not block the pores in that area.