You look in the mirror and you see them: a bunch of tiny hard white spots on your face, possibly with a slight blue tint. They don’t look or feel like a typical pimple or whitehead, so what could they be? Most likely it’s something called milia, or tiny pockets of dead skin.
“Milia are made of keratin,” says Farah Moustafa, MD, dermatologist and director of laser and cosmetics at Tufts Medical Center in Boston. They usually develop on the cheeks, eyelids, and nose. As your skin naturally exfoliates old cells so that new ones can grow, cells can get trapped, harden and become cystic – this is milia. “Think of them as pimples with nowhere to go,” says Joshua Zeichner, MD, dermatologist and director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York City.
These benign cysts — sometimes called “milk spots” — are very common in infants; about 50% of babies have it at birth, according to the Cleveland Clinic. But they can appear on anyone at any age.
What causes milia in adults?
According to the Dermatology Advisor, there are different types of milia, including neonatal milia, the type that appears on the skin of infants. The most common type in adults is primary milia; there are two other less common types, one that occurs in clusters on your skin and another that is caused by skin trauma.
Apart from the process of trapping skin cells during the natural process of exfoliation, milia can also occur due to other factors. “They can be due to sun damage or heavy skincare products,” says Dr. Zeichner. Makeup or oil-based cleansers can be the culprit if they clog your pores.
Skin damage from injury or a rash, or prolonged use of corticosteroids, can also be a possible cause. Also, certain medical conditions can cause milia to form. “Milia can be a secondary symptom of a blistering skin condition, such as a burn,” says Dr. Moustafa. “They can also occur because of an autoimmune disease or a genetic disease.” You can also get milia if you don’t clean your skin regularly, and you might be more prone to developing them if you suffer from rosacea or dandruff.
The first thing you may wonder is whether you should see a doctor if you have milia. Most often this is not necessary. “Milia are completely harmless and are strictly a cosmetic problem,” says Dr. Zeichner.
Often they just go away on their own. But if yours remain and bother you, don’t try any of the “milia removers” you see online — they’re completely ineffective, experts say.
How to get rid and prevent milia:
Do not attempt to remove them yourself.
It’s never a good idea to try pop milia like a pimple (you shouldn’t pop your pimples either!). “Never prick or push the milia,” advises Dr Moustafa. “And avoid scrubbing the milia with any type of gritty exfoliator.”
Focus on gentle cleansing.
Here’s the best daily remedy to try: “Gentle skincare,” says Dr. Moustafa. Wash your face the right way, following advice from the American Academy of Dermatology: Using a mild cleanser and fingertips, wash with warm water avoiding rubbing and rinse with warm water and dry with a soft towel. Also, make sure your skin has a chance to breathe and remove makeup from time to time.
Try topical retinoid cream.
If you have a predisposition to milia, your dermatologist may recommend trying a topical retinoid if you have a recurrence. “It can help by sloughing off cells in the outer layer of skin, encouraging the eventual release of milia from your skin,” says Dr. Zeichner.
Always wear sunscreen.
It’s a rule of thumb even if you don’t have milia, but sunburn and damage can be common contributors. Be sure to properly apply at least SPF 30 sunscreen to your skin 30 minutes before going out. Birnur K. Aral, Ph.D., Executive Director of the Good Housekeeping Institute’s Beauty, Health & Sustainability Lab, suggests applying a dollop of nickel to your face. For sprays, she suggests spraying sunscreen all over your skin, then rubbing it in.
Consult a dermatologist for professional removal.
To actually remove milia, you need to extract them from your skin. “This means that a dermatologist physically creates an opening with a needle or a scalpel blade,” says Dr. Zeichner. “Never Do it yourself. Trying to remove the milia the wrong way can lead to infections or scarring. And he adds: “Milia around the eyes are particularly difficult to treat, due to their proximity to your eyeball.”
The actual process of removing milia is called de-roofing. A dermatologist uses a needle to pull out the flap that’s trapping keratin in your skin and pull out the keratin itself. The procedure is not covered by insurance, however, and can be a bit pricey, ranging from $200 to $500 on average.
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