Milia

Milia can occur in people of any age or race or ethnicity but is most common in newborn babies. Milium cysts, which arise in groups are milia and generally develops on your cheeks and nose. They appear when the Keratin produced by the skin gets entrapped inside the skin’s outer layer.  

They are tiny cysts occurring at the root of sweat glands or hair follicles & are of 2 types- primary & secondary. 

Everything you should know about Milia


Milium is a cyst that occurs in bunches and is known as milia. It usually appears on the nose and cheeks and can affect adults or children of any age. They are whitish to yellowish and are bumpy bulges and at times also occur in rough patches. It occurs because of the Keratin entrapment under the superficial layer of the skin.

Milia can occur in people of any ethnicity, gender, or race, but mainly in newborns. They are usually not so severe and do not cause irritation or pain. But people consult dermatologists as it degrades appearance. They can be worse due to friction from clothing and extensive sun exposure. 

It is less often but also is seen affecting the torso and genitalia. People mostly misjudge and misdiagnose this as Epstein pearls and baby acne. Epstein pearls occur in newborns affecting their gums and mouth with white-yellow cysts which are not benign.

You can try these things to accelerate the healing process and can stop more milia from coming.

  • Don’t pick

If milia on your or your child’s face are disturbing you appeal-wise, don’t poke them or scratch them. The scratch can make the area open and thus germs can enter. Also if you remove the milia, it will bleed, thus can give you a long-term scar. For infants, don’t touch and pick those, leave them alone or contact your pediatrician.

  • Cleansing

Make sure to always use a gentle cleanser regularly that is free of parabens. Don’t use a hard soap that will strip your skin of essential oils, you will end up chaffing them.

  • Take steam

You can take steam post face wash to open up your pores, and thus get rid of the unwanted substances off your pores. If you have milia in your body, run hot water in your shower, soon steam will come. Sit in that steam for 5-8 minutes the steam will open your pores and will release the unwanted irritants off your body.

  • Exfoliate

Gentle exfoliation is necessary and keeps your milia at bay. After a certain age, the skin’s exfoliation power goes slow, you need to exfoliate then to prevent milia. Exfoliating agents will stop the overproduction of keratin and control sebum production. Get exfoliators with salicylic acid, glycolic acid, or citric acid.

  • Facial peel

You can use a face peel, as those also contain exfoliants, which helps skin suffering from milia. But be careful and do not use a peel with harsh exfoliants, as then you can end up getting more milia instead. If you are more used to applying facial peels rather than chemical exfoliants, keep continuing that. Moreover, use the peels that are infused with salicylic and glycolic acid. And if you have never used facial peels, don’t just start using them cause of milia. This can worsen the situation, and your skin might react to the peel ingredients.

You can try the previously mentioned methods to remove milia or protect yourself from getting secondary milia. If you tend to get milia, use creams with retinol, AHAs, use sunscreen to curb it. If you are confused about whether it is a milium, visit a dermatologist and do surgery to get rid of them. 

It is a minor surgery where they remove the milia with a needle or scalpel and deroof them. You can also opt for a laser treatment which in the case of milia is done with an electrically heated needle. If milia get into your skin easily opt for skin products that are non-comedogenic, and oil-free, with a retinoid containing cream.

Milia occurs beneath the superficial layer of the skin, and you cannot pop out or squeeze them out. This is because they don’t have an opening outside the skin surface, so squeezing them will rather lead to inflammation. In addition, if you try or squeeze it hard, you may end up scarring the skin with red marks.

Generally, it goes naturally within some days to weeks in the case of infants, and a bit longer in children and adults. But if it irritates you, which generally it doesn’t, but if it bothers your appearance, contact a doctor. Always take the help of a dermatologist to get your milia removed. There you can also remove your persistent, long-time, stubborn milia through an incision.

You might want to pop it to get rid of it just like any other pimple or blackhead. But, don’t do that, don’t try removing it at home, rather contact your doctor. The bumps under your eyes or eyelids or face must tempt you to pop, but resist yourself. 

Or if the milia are not situated at a very sensitive place like your cheek or forehead, you can try removing it yourself. But keep in mind before that its removal needs incision and can’t be popped. Although even if you don’t do anything, it will go away in few days and is not harmful.

But an incision is needed if you want to remove it before that as it is sitting deep into the skin. For removing it yourself, get a tweezer and a sharp needle, make sure those are sanitized. Then, use a gentle cleanser to clean your face, and pat dry completely. Then with the needle make an incision on the top or side of the milia, large enough to squeeze out the irritants. 

After that, use the tweezers to push those cysts out, and use an antiseptic that to prevent any infection. Carry on with your everyday skincare after that.

If your child is an infant, milia will only take a few weeks to clear up and also without any extra medication. In older children and adults, it may take a few months to resolve, but it is not painful or harmful and goes away naturally. 

If it's disturbing your appearance and aesthetic and you want to remove it immediately, contact your dermatitis specialist. You can do cryotherapy to get rid of the cysts which use liquid nitrogen to freeze the milia. Doctors mostly use this method, other than that you can go for deroofing. It needs a sterile needle for the incision to take out the unwanted cyst substance.

It can’t grow very big, the maximum size it can grow is up to two millimetres. They can be a bit bigger than whiteheads, but some people get so scared that they seem huge. These cysts are usually small and occur near the eyes, eyelids, cheeks, forehead, etc. Milia affects mostly newborns and infants rather than adults and children.

Milia though takes a bit of time, for example, some months to completely go in older children and adults. In infants, it goes away in some weeks without any medication. Doctors suggest that not doing anything and letting it heal itself gradually is the best treatment for milia. 

Adults can use exfoliation treatments which are available as OTC drugs infused with salicylic acid and AHA (Alpha Hydroxyl Acid) along with retinol. These will help your skin to heal naturally by removing dead cells and eventually helping the cyst bumps to go away.

Milia are not at all contagious or harmful, and there is no hereditary or genetic connection to this condition. It occurs in people due to the entrapment of skin protein (Keratin) beneath the skin surface. Also, it can affect anyone irrespective of age, race, ethnicity or gender.

People who are prone to milia can get recurrent cysts and it's better to take some prevention to curb these. While you can’t take any prevention in the case of newborns, you need to be cautious in the case of secondary milia. Be careful if you have other skin infections and injuries and seek a doctor if you get secondary milia.

You should avoid excessive sun exposure, or usage of thick creams to curb the reappearance of milia. Also, exfoliate chemically 2-3 times a week to keep your milia in check.

Seek the help of a doctor in cases of both babies and adults if the cysts become irritating or painful and stay till months.

The causes of milia in children and adults are different. The proper reason for milia in infants is unknown and often doctors misjudge it as baby acne. Baby acne occurs due to the mother’s hormones, and appears 2-4 weeks post-birth. But milium is a bit different from that and doesn’t sore or cause inflammation, rather they get born with it. 

Adults or older children face milia due to some skin damage like blistering because of epidermolysis bullosa (EB), porphyria cutanea tarda (PCT), or cicatricial pemphigoid. There can be blistering injuries too, like poison ivy, or burns. This can even occur due to the usage of steroid creams for a long-time or due to sun damage. 

Mature adults can also face milia due to aging as their skin can’t exfoliate normally anymore.

Types of Milia

  • Neonatal milia

This usually occurs in infants and newborns and clears up without any medication in a few weeks. They can arise in the baby’s nose, face, and even on the scalp, inside the mouth, or upper trunk. Don’t confuse this with acne as these don’t fluctuate in size and don’t cause any redness.

  • Primary milia

It can arise in both adults and children and generally appear on all over eyelids, forehead, cheeks and genitals. It can cure in a few weeks with medication but also can stay for many months.

Milia en plaque- Here, several milia bunch together to form a flat, broad patch near the affected skin, & often the patch has borders. It can happen in children or adults but mostly affects middle-aged women, in the eyelid areas, cheeks, jaws or behind ears.

People who are more exposed to the sun are at risk, as it generally occurs on the face, neck, scalp, or the upper part of the body. So if you are out in the sun, these areas are more likely to get exposed. Thus friction and UV rays invaginate your epithelial cells and cause you milia. 

If you have any other skin problem or injury, don’t get treatment for that with milia. It is often misdiagnosed as comedones or any other cyst, and in this problem, always consult a doctor. Also, chemical peeling can be the cause of milia sometimes if the chemical is very strong / the procedure is faulty. 

Chemical peeling is generally done to abolish the upper skin layer so that new skin grows without the scars.

It is not a life-threatening disease, so there is no urgency to go to the doctor. It impacts your appearance or might lower your confidence with their tiny white-to-yellow, bulging bumps. These bumps won’t give pain to you and are not itchy as well, so go to the doctor if it bothers you.

Adults generally see a dermatologist if home remedies or home exfoliation treatments fail. Treatment doesn’t get delayed in the case of babies, as they visit the doctor quite often. But, if your baby’s milia persist or are worrying you, check with a doctor. It generally occurs surrounding the eyes, nose, cheeks, and forehead in both adults and children. 

Whereas secondary milia generally target the already affected areas of your skin.

Check with a dermatitis specialist if the appearance of milia is bothering you and lowering your visuals and confidence. They usually don’t require treatment, but if you want to remove them, the dermatologist can do that for you. Though they occur in the very upper layer of the skin, you can’t pop them out or squeeze them.

Doctors do it by making a small cut and thus removing it. It is simple and painless, so no need to get scared. Also, to some adults, the doctor recommends medical therapies with ointments such as adapalene gel. In addition, there is a surgical option, like making a puncture and oozing out the contents. 

You can also try cryotherapy, which doctors perform by freezing the patient’s skin.

It is a type of cyst that bunches together and appears surrounding the nose, cheeks, eyelids, and forehead. They are small white or yellow bumps, but usually not itchy or painful. They generally don’t need treatment but is a discomfort to some people. Friction due to rough sheets or UV exposure can create or increase the milia condition by irritating those cysts.

Milia very rarely but can also appear in the torso area and genitalia. People often misjudge and misdiagnose this condition and confuse it with Epstein pearls. There, white yellow cysts appear in the gums and mouth of babies but are again not painful or irritating. Baby acne and milia are similar in some ways but are different.

In most cases, you can’t avoid or prevent milia, especially in newborns, as they are born with it. But, you can be safe from secondary milia if you protect your skin, or take care of your affected areas. You should avoid excessive sun exposure so, that the rays can’t perforate and affect your skin. 

Also, avoid using thick creams or ointments to shun the entrapment of keratin thus producing milia. As with age, the exfoliation power of your skin reduces, so exfoliation will help you prevent this condition. Milia also occurs after a chemical peel if not done right or if somebody has sensitive skin. 

In that case, apply a topical retinoid before the peeling procedure to keep milia away.

Milla always appears in clusters unlike whiteheads and are yellow to white. Also, they occur in specific areas like the nose and cheeks but can spread to eyelids and genitals as well. They mostly occur in children and babies, unlike whiteheads, and thus carry a nickname named ‘milk spots’.

While blackheads and whiteheads occur due to hormone imbalance or clogged pores, milia appear due to the skin protein entrapped in the upper layer. Also, it has various types, especially secondary milia occurs if you already have a skin condition, unlike whiteheads. Many people will get milia at a certain age, and it is difficult to avoid.

Unlike Milia, miliaria occurs due to sweat retention when the eccrine sweat glands only partially close. Though both milia and miliaria occur to already affected and sensitive skin, both are two completely different skin conditions. Miliaria is a disorder of the eccrine sweat glands which worsens in high humidity and heat. 

While it occurs due to entrapment of sweat, milia occur due to the trapping of keratin. Also, milia can happen in all ages but miliaria affects infants mostly or the newborns during their first month. It occurs due to the superficial closure of the eccrine sweat duct and mostly appears in the head, neck, and trunk. 

Milia can stay for weeks to months, whereas miliaria stays for some hours to days.

Syringoma looks similar to milia as yellow, white, or skin-colored bumps, but entirely different entities. They are not superficial like milia and rather occur much deep into the skin. And thus they are much more difficult to treat. Syringoma are permanent unlike milia which disappear in weeks to months, this condition rather has chances to reoccur. 

For normal people it’s difficult to differentiate between the two, only a dermatologist can do that. To remove syringoma there are mainly 2 ways, that is medication and surgery. Also, laser treatment can be done, which is not even needed in the case of milia. Also, in surgery, if you use the knife in case of syringoma, there is a high probability of scarring, unlike milia.

Different from milia, molluscum occurs due to the viral infection of the molluscipox virus. It generally affects kids from two to five years and appears in the face, trunk, and limbs. It can also appear in adults in genitals, but it happens less often. Tropical climates are responsible for molluscum mainly, unlike milia that have no connection to climate.

Milia are not long term, while in newborns and infants it cures within some weeks, it takes a bit longer in adults and children. Though it’s not severe, if your skin condition persists for weeks, check with a doctor.

Topical medications

There are some topical creams and cleansers to help you fight milia. Creams that contain retinoids will help you as those containing vitamin A, which is necessary for your skin. Use retinoid infused creams or even the low strength ones named retinol. Don’t use it more than once a day after cleansing or exfoliating your face. 

In addition, it’s very essential to use sunscreen if you are applying retinoid or retinol during the day. Because these chemicals make you more prone to UV damage if you go bare skin in the sun. Also, if your skin is more susceptible to get milia, there is no way you can completely run away from it, but you can curb it. You can also use AHAs, chemical peels other than retinoids and retinol.

 

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