The skin is our largest organ—the one that happens to protect our bodies from the environment—so it’s no surprise it’s also one of the most vulnerable. From acne to wrinkles, it runs the gamut of issues we’d rather steer clear of. One problem that isn’t quite as openly talked about is milia. Though harmless (as most of these skin problems usually are), milia are unsightly and annoying. Removing them can also be frustrating, but not at all impossible. Let’s learn more about milia and exactly what we can do about them.
What Are Those White Bumps on Skin?
Milia are tiny white bumps under the skin often mistaken for whiteheads. But they are not a type of acne, like whiteheads are. Milia are formed under the surface of the skin when dead skin cells become trapped in pores. Milia are made of the protein keratin, and can be referred to as keratin-filled cysts. That word sounds scary, but as we said before, milia are harmless, and usually tiny too. Their small size can often make them a little easier to tolerate.
Milia can appear pretty much anywhere on the skin, in both children and adults. They often occur around the delicate eye area, making it a little more difficult to treat. They can also appear on the forehead, around the lip area, on eyelids, cheeks and backs of arms. Around the eye area is where milia can be particularly visible and bothersome.
There are two types of milia: Primary Milia and Secondary Milia. Primary Milia occur as a result of dead skin cells accumulating and becoming trapped in pores. Usually, these dead skin cells will naturally shed and disappear, not causing any problems. But occasionally, they can turn into these small bumps, or cysts. Dead skin cells tend to also shed less as we age, which is where the importance of regular exfoliation comes in. As to the eye area, Primary Milia can occur due to products used, like eye cream, that don’t get fully absorbed into the skin.
Secondary Milia, on the other hand, occur as a result of clogged sweat ducts that occur from some damage to the skin, like those caused by laser treatments or chemical peels. Even some lifestyle issues, like smoking, too much sun damage, long-term steroid use, poor hygiene, using too many oil-based skin care products can all contribute to the formation of Secondary Milia.
Milia Removal Treatment Options
Some dermatologists or estheticians may recommend leaving milia alone, because often they can disappear on their own. It is never recommended that you try to “pop” them as you might a pimple (in fact, it’s not recommended that you pop a pimple, either). The reason being that you can cause an infection or scarring. However, there are plenty of other ways to treat milia without having to resort to picking at them with your fingers.
Exfoliation is often the top named method of getting rid of milia. That’s because exfoliation, whether physical or chemical, helps to accelerate the shedding of the very same dead skin cells that clog a pore, leading to milia. Proper exfoliation can both get rid of milia and prevent them from appearing later on.
Physical exfoliation involves using scrubs or cleansing products that contain small beads that gently grate over the milia, causing the dead skin cells in pores to loosen up. Physical exfoliation also refers to using some type of exfoliating tool, like a brush or scalpel, to scrub away the dead skin cells and boost cell turnover. This will allow the dead skin cells to become sloughed off and new skin cells to come in and replace them.
Sometimes, however, physical exfoliation can be a little too harsh. Some scrubs have beads that are too large and may cause micro-tears in the skin. These tears damage skin and can make skin more prone to infection in the future. Chemical exfoliation is typically considered the more gentle option.
Chemical exfoliation involves using a product that contains some type of safe-for-skin acid to gently slough away dead skin cells that cause milia. Alpha hydroxy acid (AHA) or beta hydroxy acid (BHA) products are particularly good at helping to shed these dead skin cells and unclog pores. Regular use (it is typically recommended to use them 1-2 times a week) can gently and effectively reduce milia in size and quantity.
Acids like AHAs and BHAs work by “un-glueing” the oil and dead skin cells that attach to each other and result in clogging. Formulyst’s Retexturing and Perfecting Serum is a great choice as a chemical exfoliant. It utilizes alpha hydroxy acids like glycolic acid to help get rid of milia. Glycolic acid can irritate sensitive skin or even normal skin if it’s used too often, so make sure you follow directions and limit use to about twice a week. If you want to pack an even greater punch against milia, you can use a cleanser that contains an AHA, like Formulyst’s Clarifying AHA Cleanser, which will help smooth away bumpy milia and even make pores look smaller. You can use this cleanser daily.
Another great treatment option for milia is the use of retinoids like retinol. Retinol, derived from vitamin A, is often used as treatment for acne and aging issues like wrinkles. It comes in different strengths, but is also available over-the-counter. Retinol will also help “unglue” the dead skin cells that gather one on top of the other to form cysts. It not only dissolves dead skin cells, but also helps to boost cell turnover in general, so you are less likely to get milia in the future. You can try Formulyst’s Anti-Aging Retinol Night Cream, which works as you sleep to slough away dead skin cells so you will wake up with clear, beautiful skin.
Extractions must be done by a professional. Never attempt to do extraction on milia yourself, as this can result in scarring and infection. You may end up making the problem worse than it ever was to begin with.
Extracting milia involves using certain tools, like a lancing tool, needle or comedone extractor. These tools are used to dig into the milia with a very small incision and thus remove the gunk inside. This is usually a quick and painless procedure done at an esthetician’s office or salon. If your milia are particularly troublesome, or if you have tried other treatments to no avail, you may want to consider going the professional route.
Milia Under Eyes and Milia on Eyelid
Milia around the eyes and on the eyelids may also be harder to scrub away or treat with retinol, and having an esthetician use a special tool to remove them may be your best bet.
Certain lifestyle factors can make milia more likely to occur (especially if you’re already prone to them), so consider living as “cleanly” as possible. This includes eating less cholesterol-rich foods like eggs and meat, always using sunblock, rain or shine, supplementing with vitamin D and limiting the use of oil-heavy makeup or skin care products. Also avoid using heavy, very moisturizing eye creams, as these can either cause milia to form or make them worse.
Preventing milia often includes using the same methods as treating them, especially when it comes to exfoliation. If your skin is prone to milia, you should have some type of exfoliating routine already in place. This can go a long way in helping to keep milia from forming.
Proper cleansing is also crucial to milia prevention. If you don’t cleanse thoroughly, you may be leaving behind oil, makeup residue and other grime that can cause skin to become clogged. Some people even recommend “double cleansing.” This involves cleansing your skin twice, first with an oil-based cleanser and then with a foaming cleanser. This ensures that all of the SPF, oil, dirt, makeup and pollution that have settled onto your skin throughout the day are thoroughly and completely removed.