Milia
Symptoms
Milia are small, white or yellowish cysts that typically appear on the face, especially around the eyes, cheeks, forehead, and nose. They are usually 1–2 millimeters in size and feel firm to the touch. Milia are not painful or itchy, but their appearance can be cosmetically bothersome to some individuals. Unlike acne, milia do not have redness or inflammation around them. They tend to appear in clusters and are often mistaken for whiteheads, though they are unrelated to acne. In adults, they can persist for weeks to months without treatment. While most common on the face, they can occasionally appear on the torso or genitals. They do not usually cause scarring, but improper extraction can lead to skin damage. Milia may recur even after successful removal.
Cause
Milia occur when keratin — a protein found in skin — becomes trapped beneath the surface of the skin. They are not caused by bacteria, clogged pores, or poor hygiene. Primary milia develop spontaneously and are common in infants, while secondary milia can arise after skin trauma (like burns, blisters, or dermabrasion) or long-term use of topical steroids. They may also develop due to sun damage, heavy skincare products, or occlusive cosmetics that impair normal exfoliation. Milia are more common in individuals with dry or mature skin, where natural exfoliation slows. Eye creams and oil-based moisturizers can sometimes worsen or contribute to their formation. People with certain genetic or autoimmune skin disorders (e.g. porphyria cutanea tarda) may also develop milia more frequently. In most cases, no underlying disease is present.
Treatment
Milia often resolve on their own over time, especially in infants. However, in adults, they usually persist and require manual extraction for removal. Treatment options include milia extraction, which involves using a sterile lancet or needle to open the cyst and remove the keratin plug — this should only be done by a trained professional to avoid scarring or infection. Chemical peels (such as glycolic or salicylic acid), retinoids, and gentle exfoliation can help prevent recurrence and encourage turnover of the skin. Hydrafacial treatments with exfoliating tips may assist in reducing future buildup. Laser resurfacing or dermabrasion can be considered in more extensive or resistant cases. It is impo
Dr. Beth Schulz-Butulis
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