Understanding Milia: The Difference from Whiteheads and How to Treat Them

Those small, pale bumps that mysteriously appear overnight – often clustered under the eyes, on the cheeks, or along the nose – are frequently mistaken for whiteheads. But resist the urge too squeeze! What looks like a mild breakout could actually be milia, a distinct skin concern that won’t respond to typical acne treatments.

“Milia are tiny cysts that sit just under the skin’s surface,” explains Dr. Emmaline Ashley, a cosmetic physician and head of education at Acquisition Aesthetics. “They are filled with keratin, a protein commonly found in yoru hair, nails, and the outer layer of skin.” These present as pearly-white bumps, but crucially, they are not inflammatory, infectious, or related to acne.

Whiteheads, in contrast, are closed comedones – a type of acne lesion caused by clogged pores filled with sebum, dead skin cells, and bacteria. “Milia, though, are firmer, deeper-set, and won’t extract easily like a whitehead,” warns Dr. Ashley.

What Causes Milia?

Your skin is a dynamic, living organ that constantly renews itself, roughly every month. As part of this process, dead skin cells should naturally shed, making way for new, healthy cells. Though, sometimes this exfoliation process falters, leading to milia.

These tiny bumps form when dead skin cells and keratin become trapped beneath the skin’s surface instead of being properly exfoliated. They commonly appear around the eyes and cheeks, areas with thinner, more delicate skin that’s prone to buildup.

“Clinically, milia are smooth, dome-shaped, and feel firm to the touch,” says Dr.Ashley. “Unlike a whitehead, they don’t have a ‘head,’ aren’t red or inflamed, and are usually not tender or painful unless irritated.”

According to Board-Certified dermatologist and founder of Skin Expert Clinic in Beirut, Dr. Hussein Yassine, milia are often seen in newborns and adults with dry or damaged skin. Several factors can trigger them, including the use of occlusive ingredients or overly rich, hydrating formulas that disrupt natural exfoliation.

“Many people mistakenly believe petroleum jelly, like Vaseline, is a moisturizer, but it isn’t,” he explains. “Mineral oils, lanolin, beeswax, paraffin, and rich natural oils like cocoa and shea butter can also contribute to congestion.” Even ingredients like dimethicone, frequently found in makeup, can cause buildup when applied heavily. Overusing rich eye creams, inadequate makeup removal, or relying on occlusive products in humid climates can also create conditions favorable for milia formation.

What causes keratin to become trapped under the skin, leading to milia formation?

what are milia? A Deep Dive

Milia (pronounced MILL-ee-uh) are tiny, pearly-white or yellowish cysts that appear just under the skin’s surface. They’re incredibly common, especially in newborns, but can affect people of all ages. Think of them as little pockets of trapped keratin – a protein found in skin, hair, and nails. Unlike blemishes caused by acne, milia aren’t related to oil production or clogged pores in the same way. They’re often found around the eyes, nose, cheeks, and forehead, but can appear anywhere on the body.

These small bumps aren’t usually painful or itchy, and they don’t indicate an underlying health problem. However, many people find them cosmetically bothersome and seek ways to remove them. Understanding why milia form is the first step towards effective management.

Milia vs. Whiteheads: Spotting the Difference

It’s easy to confuse milia with whiteheads, but they’re fundamentally different. Here’s a breakdown:

| Feature | Milia | Whiteheads (Closed Comedones) |

|——————-|————————————-|—————————————|

| Formation | Trapped keratin under the skin | Clogged pore with trapped sebum & dead skin cells |

| Appearance | Hard, small, pearly-white bumps | Flesh-colored or whitish bumps, often with a visible core |

| Texture | Firm, doesn’t easily move | Softer, may feel slightly raised |

| Extraction | Challenging to extract; squeezing can cause damage | Can sometimes be extracted carefully |

| Underlying Cause| Skin trauma, sun damage, or natural skin processes | Excess oil production, hormonal changes |

Key takeaway: Milia are under the skin, while whiteheads are in a pore.Trying to squeeze a milium can lead to inflammation, scarring, and even infection.

Types of Milia: Recognizing Different Presentations

Milia aren’t all created equal. Here are some common types:

Neonatal Milia: Extremely common in newborns, these typically disappear within a few weeks without treatment.

Primary Milia: Occurs spontaneously, often in adults.Can be linked to sun exposure.

Secondary Milia: Develops after skin injury, such as burns, blistering, or certain skin conditions like eczema. This type can be more persistent.

Encrusted Milia: Often seen in older adults, these appear as small, crusty bumps.

Eruptive Milia: less common, this presents as a widespread outbreak of milia.

Effective Treatment Options for Milia

While milia often resolve on their own, especially neonatal milia, here are several treatment options:

1. Professional Extraction: A dermatologist or trained aesthetician can carefully extract milia using a sterile needle or blade. Do not attempt this at home! This is the most effective method.
2. Chemical Peels: Light chemical peels (like glycolic or salicylic acid peels) can help exfoliate the skin and encourage the milia to slough off. Multiple sessions are usually needed.
3. Retinoids: topical retinoids (like tretinoin or retinol) promote cell turnover and can help prevent new milia from forming. Start with a low concentration and gradually increase as tolerated. Use sunscreen daily when using retinoids.
4. Laser Therapy: Certain laser treatments can help vaporize the milia. This is typically reserved for more stubborn cases.
5. Cryotherapy: Freezing the milia with liquid nitrogen can destroy the cyst.

Vital Note: over-the-counter products marketed for milia removal often aren’t effective and can irritate the skin.

Prevention Strategies: Minimizing Milia Formation

While you can’t always prevent milia, these steps can definitely help reduce your risk:

Sun Protection: Daily sunscreen use (SPF 30 or higher) is crucial. Sun damage can contribute to milia formation.

Gentle Skincare: Avoid harsh scrubs and abrasive cleansers that can irritate the skin.

Proper Wound Care: If you experience a skin injury, keep it clean and protected to minimize the risk of secondary milia.

Hydration: Keeping your skin well-hydrated supports healthy skin cell turnover.

Avoid Occlusive Products: Heavy creams and oils can sometimes contribute to milia, especially if you’re prone to them.

Milia and Skin Health: A Dermatologist’s Outlook

As a dermatologist, I frequently encounter patients concerned about milia. It’s critically important to remember that they are a benign condition. However, I understand the frustration they can cause.

Case Study: I recently treated a patient in her late 40s who developed secondary milia after a severe sunburn.After a series of gentle chemical peels and consistent sunscreen use, her milia significantly improved.

Real-World Example: Many of my patients find that incorporating a gentle retinol serum into their nighttime routine helps prevent milia recurrence.

Benefits of Addressing Milia

Beyond cosmetic improvements, addressing