Overview

Milia are small, white or yellowish bumps that typically appear on the skin, most commonly on the face. They occur when keratin, a protein found in skin, becomes trapped beneath the skin's surface. Milia are completely benign (non-cancerous) and are often described as “milk spots” due to their pearly white appearance. They are especially common in newborns but can occur in people of all ages. While milia are harmless and usually painless, many people seek treatment for cosmetic reasons.

Causes

The main cause of milia is the trapping of dead skin cells (keratin) under the skin’s surface. Depending on the type, the causes may vary:

• Primary Milia: Develops spontaneously when keratin becomes trapped during natural skin shedding. Common in babies and adults.
• Secondary Milia: Occurs after skin trauma such as burns, blistering conditions, or procedures like dermabrasion or laser treatments.
• Sun Damage: Chronic sun exposure can lead to changes in the skin, increasing the risk of milia.
• Heavy Skin Care Products: Use of oily creams or thick makeup may clog pores and contribute to milia formation.
• Aging: Skin cell turnover slows with age, making older adults more prone to milia.

Symptoms

Milia are primarily identified by their distinctive appearance and typically do not cause pain or discomfort. Common symptoms include:

• Small, Dome-Shaped Bumps: Typically 1-2 millimeters in size, white or yellow in color.
• Most Common on the Face: Frequently seen around the eyes, cheeks, nose, and forehead.
• No Redness or Inflammation: The skin around the milia is usually not irritated unless scratched or inflamed by external factors.
• Painless: Milia do not itch or hurt.
• Clusters or Single Bumps: They may appear singly or in groups.

Diagnosis

Diagnosing milia is simple and typically based on clinical appearance alone:

• Physical Examination: A dermatologist examines the skin visually without needing any special tests.
• No Laboratory Tests Required: Milia are easily recognized by their classic look, making additional testing unnecessary.
• Differential Diagnosis: Doctors may rule out other skin conditions like acne, whiteheads, or cysts, but milia are distinguishable by their lack of inflammation and consistent size and color.

Treatment

Although milia often resolve on their own, treatment options are available for those seeking faster removal or cosmetic improvement:

• No Treatment (Observation): In infants, milia typically clear within a few weeks without intervention.
• Manual Extraction: A dermatologist uses a sterile needle or blade to gently remove the milia in a safe environment.
• Topical Retinoids: Prescription creams containing retinoids help exfoliate the skin and prevent new milia from forming.
• Chemical Peels: Mild chemical peels can help slough off dead skin cells, reducing the likelihood of milia formation.
• Laser Therapy: In some cases, laser treatments are used to effectively remove stubborn milia.
• Gentle Skin Care: Using non-comedogenic (non-pore-clogging) products, regular exfoliation, and proper cleansing can help prevent recurrence.

Prognosis

The prognosis for milia is excellent:

• Self-Resolving in Infants: Most newborns' milia clear naturally within a few weeks.
• Good Cosmetic Outcome: With simple procedures, milia can be safely and effectively removed without scarring.
• Low Risk of Recurrence: With proper skincare, recurrence is minimal, although some individuals may be prone to repeated occurrences.
• Non-Dangerous: Milia do not indicate any serious health problem and are purely a cosmetic concern.

Overall, milia are harmless and treatable, and individuals can achieve smooth, clear skin with minimal intervention when needed.