Not all white bumps are acne.
If you’ve ever developed a milium cyst, you quickly realize these small, pesky bumps are infinitely more difficult to remove than whiteheads or other acne bumps. Many patients try to squeeze them out but ultimately fail (and instead make matters worse from the trauma of picking).
Don’t let these small yet stubborn cysts frustrate you. A lot can be done to treat and prevent milia, but first, one needs to understand what they are and why they occur.
Milia is the medical term for small, keratin-filled cysts that can be seen in all age groups. These cysts can be solitary (milium) or appear in clusters (milia). They are most commonly seen in infants as tiny, firm, whitish bumps on the cheeks or around the nose and eyes. Nearly half of all infants develop them. Adults can develop milia on the face as well, including very delicate areas like the eyelids. Milia can even form on the arms or hands, especially in older patients with severe sun-damaged (think leathery) skin or those with certain acquired or genetic skin conditions associated with blistering. In all cases, however, milia are benign and treatment is not necessary since they can eventually go away on their own.
Milia form as a consequence of the skin’s localized inability to naturally exfoliate. Dead skin cells—composed predominantly of keratin, a protein also found in hair and nails—build up underneath, causing a bump to form. Unlike acne, milia are cysts, do not form from a pore and typically do not get inflamed or develop redness or swelling.
So what needs to be done? In most cases, nothing. In due time all milia will resolve spontaneously, so it’s perfectly reasonable to leave them alone. However, when waiting is not an option, especially for those with very persistent or cosmetically bothersome milia, treatment should be considered with the help of your dermatologist. Here are some things you can do.
Products that boost exfoliation and cell turnover keep the skin smooth and thin, thereby eradicating milia and preventing them from recurring. I highly recommend Skinceuticals Micro-Exfoliating Scrub, which is gentle enough to use daily without leaving the skin overly dry or irritated. After slightly wetting your fingers, massage this product along your face using small circular motions. Just a few minutes are all your need to give your skin an instantly smoother feel and appearance.
Products containing glycolic acid and retinol are also fantastic milia-busters. These products are considered very safe, but some caution is needed when using these products around the eyes where skin is thinner and inherently more prone to irritation. Glycolic acid is available in over-the-counter creams or gels in 20% or lower concentrations. Consistent use of this natural alpha-hydroxy acid at low doses gives the skin a consistent rate of exfoliation without excess irritation. Peter Thomas Roth Glycolic Acid 10% Hydrating Gel does an excellent job exfoliating without leaving the skin too dry. A thin layer applied every other evening is typically sufficient to give your skin a brighter and smoother appearance. Let the product dry for ten minutes, then apply a moisturizer on top before going to bed.
Retinol is another milia-eradicating ingredient. Nightly use of low concentrations, like that found in Skin Medica Retinol Complex 1.0, gently increases the skin’s cell turnover rate, revealing a fresh smooth layer. For those with sensitive skin, it’s wise to start with a thin layer applied only every other night before ramping up to daily use. Remember to always follow up with an evening moisturizer to counteract dryness and irritation. For especially stubborn or numerous milia, prescription retinol creams (like Retin-A or generic tretinoin 0.025% – 0.05% cream or gel) may be in order. Consult your dermatologist to discuss these options.
For those who simply can’t wait the number of weeks required for topical exfoliating treatments to work their magic, manual extraction by your dermatologist can provide a quicker solution. A sterile needle or blade is used initially to create a small opening in the cyst. Afterwards, the bump can either be left alone to spontaneously decompress with routine cleansing or exfoliating, or extraction using a comedone extractor can be done to remove the cyst manually by gentle pressure. In skilled hands, little trauma and no scarring should be produced. I caution my patients against doing this at home on themselves. Improper technique can cause excess skin trauma leading to hyperpigmentation (dark marks) or even permanent scarring.
The best course of action of course is to not get them in the first place. This is why sunscreen is critical. Sun damage is a known contributor to milia formation, so every morning routine must include application of sunscreen (at least an SPF 30). I recommend EltaMD UV Daily Broad-Spectrum SPF 40 because it contains micronized zinc oxide (which provides the optimum sun protection by blocking both UVA and UVB radiation). It feels light, smooth and non-greasy on the face. It won’t leave a white sheen or increase breakouts. Apply after cleansing and moisturizing.
With a solid routine in place that incorporates daily sun protection, gentle exfoliation at home, and in-office extraction as needed, your skin could be smooth, radiant, and milia-free!