5 Key Facts About Milia

Beauty concerns range from acne to sensitive skin, and there's one issue you might not even recognize by name. Have you ever noticed tiny, pearly-white bumps around your cheeks and eyes? Unlike acne, which is usually easy to spot due to its size and redness, these small white bumps often go unnoticed and leave many people wondering what they are, what causes them, and how to get rid of them.

To start: these bumps are not a rash, nor are they the result of an infection or allergy. They are called milia, and fortunately, they are harmless. Most people notice them simply by seeing them in the mirror, rather than because they cause any discomfort.

Milia come in two main types: primary and secondary. In this section, we'll explore what causes each type, as well as available treatment options and ways to prevent them.

Primary milia are most commonly found in infants, so we’ll start our discussion on milia with pediatric milia.

5. Milia in Infants

Infants frequently experience rashes and skin irritations, ranging from diaper rash and cradle cap to baby acne and milia. Around 40 percent of newborns develop pediatric milia, typically appearing within the first week after birth [source: Agrawal].

Pediatric milia and baby acne are often mistaken for one another, but they are actually quite different. Not only do they look different (with distinct colors), but they also have different causes. Baby acne consists of red pimples that usually develop three to four weeks after birth and primarily affect the face (on the cheeks, nose, and forehead) [source: MedlinePlus]. Although there are various theories, the exact cause of baby acne remains unknown.

Like baby acne, pediatric milia typically appears on the face (cheeks, chin, and forehead), but instead of red pimples, it manifests as small white bumps no larger than two millimeters in diameter [source: Agrawal]. This harmless condition occurs when dead skin cells become trapped near the skin's surface rather than sloughing off. When it happens inside the mouth, it is referred to as Epstein's pearls.

Just like baby acne, pediatric milia and Epstein's pearls will resolve on their own without any treatment.

4: Factors Behind Primary Milia

While primary milia is most commonly seen in infants (pediatric milia), this type can develop in individuals of all ages and races. Primary milia appear without any apparent cause.

It's believed that primary milia occur in newborns because their sebaceous (oil) glands are not fully developed, which means their skin cannot exfoliate naturally [source: The Permanente Medical Group]. In older children and adults, primary milia form when dead skin cells and sweat become trapped near the skin’s surface and turn into small cysts of keratin without a way to escape.

Although primary and secondary milia may appear similar, they are caused by different factors. Let's now explore the causes behind secondary milia.

3: Factors Behind Secondary Milia

Secondary milia may resemble primary milia, but they are caused by blocked sweat ducts in the skin. This often occurs after skin trauma, such as blisters from burns, poison ivy rashes, or intense dermabrasion treatments.

Sunburns and excessive sun exposure are common contributors to milia. When skin is damaged by the sun, its outer layers thicken. As dead skin cells try to reach the surface to shed but are blocked by the thickened skin, they form small keratin cysts, which become milia.

Certain chronic skin conditions are linked to the development of milia. Other factors such as tattoos, the use of potent topical corticosteroids, and allergic reactions like contact dermatitis can also trigger the appearance of secondary milia.

2: Ways to Treat Milia

Primary milia is composed of keratin, a protein naturally found in the skin, and forms when dead skin cells become trapped on the skin's surface. This condition is entirely harmless, and while it may be unsightly, it will clear up on its own after a few weeks without the need for treatment [source: CNN].

During the presence of milia, it's important to adjust your skincare routine to be as gentle as possible. Choose products that are non-comedogenic and avoid using anti-aging creams, which might hinder the healing process. Although exfoliating may seem like a solution, it's not effective since milia forms from the inability of dead skin cells to shed properly. In fact, it's best to skip exfoliating the affected areas to prevent skin irritation, which can contribute to the development of milia.

If you have the secondary form of milia (which may not be recognized until the condition persists for a few months and you consult a doctor), professional treatment will be necessary. Options for treatment include prescription retinoid creams like Retin-A® and alpha hydroxy acid peels. In some cases, removal of the bumps may involve a procedure that uses a scalpel or needle to pierce each milium, followed by a comedone extractor to remove the milia, similar to the process of extracting blackheads [source: Skin Sight].

1: Prevention

Although there is no guaranteed method to prevent milia from forming, there are steps you can take to reduce the risk of its appearance.

One of the primary causes of milia is skin damage due to sun exposure. Always apply sunscreen, no matter the season, and even on cloudy days. Interestingly, milia can also result from what you might think is beneficial skincare. Despite your efforts to pamper your skin, certain products can cause irritation. For example, that rich, thick night cream you swear by could be the culprit behind those tiny white bumps on your face. Products that cause irritation, burning, or friction heighten the chances of developing milia, and unfortunately, even creamy or comedogenic skincare items are partly to blame. If a product prevents dead skin cells from naturally shedding, it could lead to the formation of milia.