What Is Milia and How Do You Treat It? October 10, 2013

There are some skincare issues that, in my opinion, are more vexing than others.  To name a few –  hyperpigmentation, acne, and milia.  Just what is milia, how do you get it, and how do you treat it?

What is Milia and What Causes It?

According to Dr. Ellen Marmur in her book Simple Skin Beauty (pages 201-206) milia and whiteheads are very similar:

… both are closed-over keratin plugs – but milia is not associated with acne.  They are caused by aging and slower cell turnover.  Milia are tiny white bumps formed by trapped keratin compacted in the pore, but there is no bacteria or oil involved.  …

Milia is a case of keratin-obstructed pores caused by skin that isn’t shedding normally.  It is not an acne issue and happens frequently as we age; it generally starts to show up in your thirties.  Milia can also be a side effect of laser resurfacing, because the skin is growing at an accelerated rate (as a wound-healing response) and can trap keratin inside the pores.

The website Dermadoctor expands further on the causes of milia in an article by Dr. Audrey Kunin :

Milia are deep seeded white bumps that form when skin cells become trapped rather than exfoliate naturally. The trapped cells become walled off into tiny cysts that appear like white beads below the surface of the skin. Milia can occur on the skin or even on mucous membranes such as the inner surface of the cheek or the vermillion border of the lips.

As the surface is worn away, the tiny cyst may resolve on its own. Far too often, though, intervention to remove the cyst may offer more rapid resolution.

Why Me?

Milia form for a variety of reasons. Some you can fix, others aren’t so easily dealt with. But you need to scrutinize your skin care routine whenever milia make their appearance. Although some people naturally make milia, and I certainly expect everyone to have an occasional bump at one time or another, milia are often the result of a problem that has affected the skin’s surface.

Are there any skincare habits that contribute to the formation of milia?  According to Dr. Kunin yes there are:

• No doubt the most common reason milia form is from smothering your skin with heavy skin care products or hair care items. Comedogenic creams and lotions may prevent the sloughing of dead epidermal skin cells. Hidden problem products include make-up removers not labeled oil-free or non-comedogenic, hair spray, hair mousse and gel, heavy sunscreens and some moisturizers. The eyelids are very thin and more likely to experience problems with milia due to cosmetics. Re-evaluate your eye make-up and eyelid make-up remover if you are finding this to be a concern.Certain lipsticks, lip balms and products meant to help with chapped lips may be the cause of little white pearly milia developing around the lipstick edge (aka vermillion border) of the lips. Again, if you see these forming, take a good look at the ingredients on the label.
• Prolonged History Of Sun Damage
  The formation of milia can also be due to cumulative sun exposure. Aging skin forms a thicker epidermis that may make it far more difficult for skin cells to find their way out of the glands. And thicker skin also makes for more road blocks in the pathway to exfoliation.
• Porphyria Cutanea Tarda
  Milia can also be associated with certain skin diseases, particularly blistering disorders such as Porphyria Cutanea Tarda. Fortunately, there are other symptoms associated with these blistering diseases. Blisters, for one and increased hair on the face and backs of hands and knuckles, for another. PCT is an unusual disorder. If you have milia, don’t initially jump to the conclusion you have a blistering condition.
• Genetics
  Sometimes we just inherit certain undesirable skin tendencies.

What Can Be Done to Prevent and Treat Milia?

Both doctors I quoted above believe that regular exfoliation and retinols can help fight milia.  Dr. Kunin explains:

Exfoliation can go a long way in helping deal with milia prone non eyelid skin. By keeping the epidermis thin and smooth, you can cut down on their formation. By mentioning exfoliation, I’m not talking about scrubbing off the top layer of your skin!

Retinol is also very helpful for both fighting and preventing milia. Again, retinol should not be applied to the upper eyelids.

Sometimes milia won’t come out in spite of your best efforts. Then you may need the milia to be extracted by your dermatologist. In a physician’s office, milia are easily removed. The skin is cleansed with some rubbing alcohol or other antiseptic. The skin overlying the milia is gently opened with a sterile lancet or needle. Then pressure is applied with a comedone extractor, and the milia typically pop out. I find that one of the most difficult areas from which to remove milia is the upper eyelid. There simply isn’t a good way to press on the area and avoid the eyeball, so the lid has to be pulled either upwards or to the side, which is somewhat challenging.

Furthermore, since extensive sun exposure can cause milia be sure to be vigilant, if you weren’t already, with using a sunscreen that won’t clog pores.  And if you’ve tried everything to get rid of your milia and it isn’t working please see a professional.  Don’t go stabbing your face with a needle on your own.

Further Reading:

• For information about milia in babies, which is very common, see this article from The Mayo Clinic
• Ask an Expert: An Answer for Those Unexplained White Bumps – New Beauty
• Don’t Let Your Aesthetician Do This – New Beauty

Image from jacintak.com