Milia Are NOT Pimples!
If you've had milia, you likely wondered if they were some kind of pimple. While many people mistake the tiny, pearl-like bumps for acne, they are not the same thing. One of the easiest ways to identify milia bumps are by how they feel.
Unlike acne, milia are rather firm, and squeezing has little to no impact on them. Also unlike acne, these bumps can show up around the eyes and on parts of the face where there aren't active oil glands. Milia also don't have the pain associated with acne when a pimple forms and then becomes inflamed and sore.
Note: If you have yellowish bumps around your eyes and on your eyelids, they may not be true milia (which are typically translucent flesh to white). You may instead be dealing with a skin growth known as a xanthoma. These bumps are common in people who have high cholesterol or high triglyceride levels.
So How Did I Get Milia, Anyway?
Milia occur when dead skin cells get trapped under the skin's surface, forming small, hard cysts. It's estimated that nearly 50% of infants in the United States get milia, in part because their young skin is still "learning" to exfoliate. As their skin matures, the milia will disappear on their own. Doctors don't consider infant milia to be a problem, and rarely prescribe treatment for it. Parents may find the bumps unsightly, but the baby isn't bothered by them, and they have no impact on the baby's health.
Adults can get two forms of milia: primary and secondary. Primary is the type seen in babies, caused by skin cells that build up because they just didn't exfoliate properly. Secondary milia happens when a skin condition that leads to blistering actually damages the pore lining. Burns or severe rashes can increase the number of skin cells trapped under the skin's surface.
Sun damage is also a contributing factor to milia because it makes skin rough and leathery, so it's more difficult for dead cells to rise to the skin's surface and shed normally.
How to Treat and Prevent Milia
Because milia often go away on their own without treatment, being patient and waiting it out is an option—but waiting is definitely not for everyone!
Primarily, it is critical that you not squeeze, scrape, poke, or in any other way physically try to remove the milia from your face as you would a pimple. Because milia are hard and under the skin's surface, these methods are unlikely to help. Instead, you wind up irritating and damaging the skin surrounding the cyst. Some people have even scarred themselves trying to dig out milia—and there's no question a scar will last longer than any milia bump!
Because milia can form when the skin's natural exfoliation process malfunctions, you can use a targeted exfoliating treatment with salicylic acid to immediately improve exfoliation and allow the bump to dissolve on its own relatively quickly.
Of course, you also can see a dermatologist, who can tell you which type of milia you have. Secondary milia might require a doctor to use a hypodermic needle to remove the cyst, or cryotherapy, which involves freezing the cyst and then removing it. If your milia don't respond to an exfoliating treatment after several weeks, consider making an appointment with your dermatologist.
Although not a lot can be done to prevent milia, maintaining a suitable skin-care routine certainly helps minimize the chance of them appearing. Because secondary milia can be caused by sun damage, always use a moisturizer with at least SPF 15 to protect your skin every day, and give those annoying white bumps less of a reason to set up shop on your face!
Yes, milia is a real pain to put up with, but there are things you can do to treat it. Remember: Patience, daily exfoliation, sun protection, and resisting the temptation to take matters into your own hands can go a long way to having clearer, bump-free skin sooner!
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Nelson Textbook of Pediatrics, 18th Edition, Saunders Elsevier, 2007, Chapter 646; Dermatology, Mosby, 2003, pages 1722–1723; Fitzpatrick's Dermatology in General Medicine, 6th Edition, McGraw-Hill, 2003, pages 601, 604, 780; Current Diagnosis & Treatment: Pediatrics, 19th Edition, McGraw-Hill Medical, 2008; and http://emedicine.medscape.com/article/1213423-overview.