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Tiny White Spots? Or Milia? Here's Why it's Important to Know the Difference

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There are many skin conditions that we regularly talk about here at Sönd. We discuss acne, psoriasis and rosacea and oily, dry or sensitive skin a lot. Plus all the other skin conditions that can make our skin feel non conformist and well, a bit contrary.

Of course, there’s always others that we haven’t (yet) discussed, and this week, we put milia in the Sönd skin spotlight.

What are milia, what causes them, are they dangerous and what can we do about them if we have them?

What are milia?

Milia are tiny, white headed, raised bumps that form on the skin of the face and chest. They’re most common on the skin around the eyes and eyelids, nose, cheeks and forehead. That said, it’s still possible to develop milia anywhere else on the body, including the back and genital area.

They can sometimes appear yellow, but more often than not, they’re white or pearlescent white and measure around 1-2mm in diameter. They’re most common in babies that are a few days old, hence their common nickname, ‘milk bumps’. Many adults however, do develop milia later in life.

When milia appear on the skin of newborn babies, they often clear up quickly. But in adults they tend to linger for a long while and may need treatment, depending on how long they last and the size of the area they cover.

Milia are not actually spots, and despite their similar appearance, are very different to whiteheads.

Whiteheads are caused by a buildup of dead skin cells, dirt, makeup and natural skin oil called sebum. They can be squeezed, although we advise against it, as unlike blackheads, they’re covered by a layer of skin. Blackheads are not covered by a layer of skin and are therefore exposed to the air, making them easier to squeeze. But we still don't recommend picking at blackheads.

Instead, milia are a type of cyst rather than a spot. They often form in clusters in one or more areas of the face. (One milia bump on its own is called a milium, but they’re not often found on their own. Milia is the plural name for the groups of milium bumps that cluster together and is a more common term than milium.)

Milia are caused by the buildup of a natural skin protein called keratin becoming trapped just below the skin’s surface. Keratin is a very strong protein that makes up the majority of our hair and nails, but also forms part of the skin.

Why do milia form?

The cause of milia in babies is unknown, and as we mentioned above, they soon clear up anyway. But in adults, they’re often caused as a consequence of keratin containing dead skin cells that become trapped in the pores. This is called primary milia, and is also the type of milia that some babies suffer with.

They also commonly form due to some form of physical damage to the skin, or lifestyle factors, both of which can cause the pores of the skin to become blocked, trapping keratin. These are called secondary milia.

Skin damage leading to secondary milia can be caused by physical trauma, burns, blisters, prolonged exposure to UV light and using steroid creams for long periods of time. Using skin care products that contain liquid paraffin (such as Vaseline) or petroleum oil can also cause secondary milia by trapping keratin in the pores.

Sometimes, skin treatments such as laser resurfacing, dermabrasion and chemical peels can cause secondary milia to form, too.

Lifestyle factors can also contribute to the development of secondary milia. These include not cleansing the face properly on a regular basis, smoking, a chronic lack of sleep and using oily skin care products on already oily skin.

How are milia treated?

Milia cysts in adults can, and often do, clear up over time on their own. The trapped keratin deposits can work their way upwards towards the surface of the skin over a number of weeks or months, and disappear that way.

But if your milia cysts are lingering and causing you upset, then please, please, avoid squeezing them. Take it from us. Milia shouldn’t ever hurt or feel uncomfortable, but squeezing them will cause you pain in the form of broken, irritated skin.

You’re unlikely to ever be able to bring milia to the skin’s surface when they’re not ready to come naturally by themselves. Trying will only make you succeed in making your skin red, inflamed and even weepy. Plus, your milia cysts will still be there.

So milia treatment is best left to the professionals. There are a number of options available to you, and your skin care professional will be able to advise which milia treatment might be best suited to you.

Milia treatments include using tools, lasers and / or heat to physically remove the cysts. Milia removal tools usually involve sterile needles that enter the skin to gently push the cyst to the surface.

Other options include laser ablation, heat diathermy and cryotherapy - a freezing technique using liquid nitrogen.

They can all feel uncomfortable and have varying levels of recovery and risk of scarring. Your skin care professional can tell you more.

They may also suggest a chemical peelusing a fruit acid such as salicylic acid to remove the top few layers of skin. This should make the milia cysts more accessible and easier to remove.

Can milia be prevented?

Adopting a good skin care regime can help to avoid developing milia cysts, or prevent them from returning.

This means cleansing the skin of dirt, makeup and pollution twice a day using a gentle, nourishing skin cleanser. Regular exfoliating twice a week (or less frequently if your skin is very sensitive or stressed out) will also help to keep the pores free from a buildup of clogging materials.

Our brand new Clear Out Face Mask can also help to keep the pores clear and the skin bright!



Hannah de Gruchy BSc(Hons)

About Author

Hannah de Gruchy is a freelancer writer who specialises in health and wellness. She has a keen interest in the biology of skin and loves using her words to help separate the real science of skincare from the pseudoscience of some skincare brands. Hannah has a degree in Human Biology and many years’ experience working in laboratories around London. Using this experience, Hannah enjoys turning complex science into interesting, engaging and easy to digest pieces to read. In her spare time, Hannah runs, practices yoga and loves cooking plant based foods.

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