Milia vs Whiteheads: What's the Difference Between these Tiny White Bumps?
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 conditions that can make our complexion 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 a condition called milia front and centre.
What are milia and what causes them? Are they dangerous and what can we do about them if we have them? Why do some people get milia and are these hard white bumps on your face ever going to go away?
If you have this complaint, then you're probably keen to learn more. So here’s all the answers to the questions you have regarding milia, and how to get rid of it.
What Are Milia White Spots on the Face?
Milia are small cysts that look like tiny, white headed, raised pimples that form on the face and chest. They’re most common around the eyes and eyelids, nose, cheeks, chin and forehead. That said, it’s still possible to develop milia anywhere else on the body, including the back and genital area.
Also known as milium cysts, these small white bumps often form in patches or clusters and are fairly common.
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What Do Milium Cysts Look Like?
Whilst they can sometimes appear yellow, more often than not, milia look white or pearlescent white and usually measure around 1-2mm in diameter. They’re most common in babies that are a few days old, hence their common nickname, ‘milk spots’ due to their white appearance. Milia are very common however in adults who become prone to them later in life.
When neonatal milia patches appear on the skin of newborn babies, they often clear up quickly. But adult cases of milia can last a lot longer, often many months, and may need treatment, depending on how long they last and the size of the area they cover.
Milia aren't actually a form of acne, and despite their similar appearance, are very different to whiteheads. But what is the difference between whiteheads and milia?
What Are Whitehead Acne Spots?
Whiteheads are caused by a buildup of dead skin cells, dirt, makeup and natural 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 this layer and are therefore exposed to the air causing them to become black, making them easier to squeeze. But we still don't recommend picking at blackheads.
Milia vs Whiteheads
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 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 that cluster together and is a more common term than milium.)
Milia are caused by the buildup of a natural protein called keratin becoming trapped just below the skin’s surface. Keratin is a very strong protein that also makes up the majority of our hair and nails.
Why Do Milia Form?
There are a few different types of milia, depending on when they develop. 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. Secondary milia is a form of milia that generally occurs when something happens on the outside of the skin...
Damage to the Skin
For example, milia can also be due to some form of physical damage to the skin, or lifestyle factors, both of which can cause the pores to become blocked, trapping keratin. These are called secondary milia.
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 skincare products that contain liquid paraffin (such as Vaseline) or petroleum oil can also cause secondary milia by trapping keratin in the pores.
Certain Skin Treatments
Sometimes, beauty treatments such as laser resurfacing, dermabrasion and chemical peels can cause secondary milia to form, too.
Lifestyle Factors and Milia
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 beauty products on already oily skin.
The cause of milia, that is, a buildup of keratin for whatever reason, is therefore the main difference between milia and whiteheads.
Skincare and Treatment Options: How To Get Rid of Milia
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 or trying to extract milia will cause you pain in the form of broken, irritated skin.
How do we get rid of milia? Can we treat milia? You’re unlikely to ever be able to bring milia to the surface when they’re not ready to come naturally by themselves. Trying to remove milia will only make you succeed in making your complexion red, inflamed and even weepy. Plus, your cysts will still be there.
Therefore, milia treatment, especially so, when around the eye area, is best left to the professionals. There are a number of options available to you, and your dermatologist will be able to advise which treatment might be best suited to you. If you're prone to milia they may also be able to recommend ways to prevent milia from returning.
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 dermatologist can tell you more. They may also suggest a chemical peel using 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 you avoid developing milia cysts, or prevent them from returning.
This means cleansing away dirt, makeup and pollution twice a day using a gentle, nourishing 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 Purifying Clay Mask can also help to keep the pores clear and the skin bright!
What Else Could Be Causing Little White Spots On My Face?
If you have white pimples on your face and you’re still unsure of the difference between milia and comedones (the technical name for blocked pores, whiteheads and blackheads) then there are various other reasons why your skin may be acting up…
Blocked pores are another cause of white (or sometimes black) spots and bumps. These types of pimples are usually white or the same colour as your skin, causing the surface to feel rough and uneven.
A white comedone will have a ‘plug’ of sebum, the skin’s natural oil, at the top of the spot. Milia will just contain keratin. White comedones are very common, just like milia are, and tend to affect those with naturally oily skin more.
Comedones aren’t usually accompanied by a red, inflamed, angry complexion. But there is a chance they can become inflamed, especially if you neglect your cleansing routine or you pick at them.
Sebaceous hyperplasia is a condition that looks similar to acne. But in fact, it results in an enlarging of the sebaceous glands that are responsible for the production of sebum, or the natural oil of the skin.
The sebaceous glands are located deep within the layers of the skin and their role is to produce enough sebum to keep it healthy, moisturised and protected. But if they become enlarged, they become visible and palpable from the surface of the skin. This results in an uneven complexion, and white or flesh coloured bumps.
Sebaceous hyperplasia therefore looks similar to milia and the two can be confused. However, to tell them apart, use this helpful rule - bumps caused by sebaceous hyperplasia have a ‘pushed in’ area in the middle of the bump, whereas skin bumps caused by milia don’t.
This skin condition is most common in people over 40 years and it can also be mistaken for certain types of skin cancer. If you're in any doubt about a bump or blemish, speak to your GP as soon as possible.
Similar to sebaceous hyperplasia, sebaceous cysts cause small bumps to form near the surface of the skin. However, unlike sebaceous hyperplasia bumps that can be hard or soft, sebaceous cysts usually feel soft to the touch.
Skin bumps caused by sebaceous hyperplasia also feel static, in that they can’t be moved under the skin. The fluid filled sacs caused by sebaceous cysts on the other hand can move around under the skin if you push gently with your finger.
These kinds of cysts are filled with the protein keratin and oil and surround the sebaceous glands if the opening to the gland becomes blocked. They’re usually white, yellow or flesh coloured and occur most commonly on the face, neck and scalp. It’s also common to experience sebaceous cysts on the back and shoulders.
Sebaceous cysts don’t generally cause pain or discomfort, unless they grow larger or they become infected.
Starting off as small white or flesh coloured bumps, seborrheic keratoses usually become larger and turn brown in colour over time. Most common on the face, they can also appear anywhere on the body and can grow to an inch in diameter.
In the early stages, they can appear similar to milia, and can therefore be confused. However, look closely, and seborrheic keratoses look like they’re ‘stuck’ to the skin, like a drop of wax that could be pulled off. They're most common after middle age.
Supporting Your Skin with Sönd
If you think you may have milia, speak to your GP if you’re concerned. Find a beauty regime that suits you and your complexion, that includes regular cleansing and exfoliating, and a non pore blocking day and night moisturiser. The Sönd alkalising skincare range is ideally suited for anyone with skin that doesn't like to conform, and could help you manage your milia.
This article is not meant to treat or diagnose. Please visit your doctor for advice about any health concerns you may have.