Those tiny white bumps on your face aren’t pimples
Don’t worry—they might be milia and they’re totally treatable.
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There is always something to learn about your skin. For example, pinhead-sized white bumps that may appear like pimples (when they appear solo) or texture (when they pop up in a cluster) could actually be a skin condition called milia. This common nuisance can appear anywhere on the body, but most often crops up on the face around the eyes. And odds are, you’ve experienced these, even without realizing they have a specific name. To learn more about milia, we spoke with Dr. Isha Tiernan, a dermatologist with Tufts Medical Center in Boston.
What is milia?
Milia consists of small, smooth, sometimes dome-shaped bumps on the skin that are white or yellowish in color and one to two millimeters in size. You can get milia despite skin color or age—in fact, it’s commonly referred to as “baby acne” on infants, despite not being acne. “These are little tiny cysts filled with dead skin cells that are underneath the surface of the skin,” Tiernan says. Unlike pimples, which are filled with pus, oil, bacteria, and other inflammatory things, these cysts are composed of compacted keratin, the protein that makes up skin, hair, and nails. They are also asymptomatic, meaning you won’t see inflammation or feel discomfort that’s associated with acne.
What causes milia?
If you have a milium cyst on the skin, do not try to pop it. (Side note: Avoid squeezing any blemish, as it can introduce bacteria to the wound that may cause an infection and even leave a scar behind.) The quickest way to remove it is by seeing a dermatologist or esthetician who can do an extraction. “We will usually—either under local anesthesia or no anesthesia—take a small blade or a needle and ‘de-roof’ the top of the skin over the milia and then use some type of tool that’s a comedone extractor to express the contents of the milia, the compact keratin,” Tiernan says.
If you opt to get the milia extracted, you can expect some bruising that’ll last as long as a typical bruise for you—about a week or so. You may also see redness right after the procedure, but once healed, there shouldn’t be a lasting scar.
You may alternatively opt to leave milia alone, as they’re not harmful and should go away on their own as the skin cells naturally turn over. Milia can go away in as little as a week or take months to dissipate, depending on how large they are (smaller ones should go away faster). One reason you may not want to get a milia extraction is that it’s typically considered a cosmetic procedure and most insurances won’t cover the cost, which varies from place to place. Milia can also reform in the future, meaning additional costly visits if they really bother you. If you decide against it, you can treat milia with a prescription-strength retinoid, such as tretinoin, that can exfoliate the area and cause the skin cells to turn over quicker (it also works as a preventative for future milia).
How do you prevent milia?
The first step to preventing milia is taking a look at your skincare routine. Tiernan suggests using a gentle cleanser and a lightweight moisturizer that are both oil-free and noncomedogenic (meaning they won’t clog pores). For this, try the Cerave Hydrating Facial Cleanser and Daily Moisturizing Lotion, both of which have thin formulas that contain hydrating hyaluronic acid and skin-protecting ceramides.
Sunscreen is a daily skin essential but can be greasy and clog pores. Look for one that has broad-spectrum coverage of at least SPF 30 to protect your skin from the sun’s UV rays and is oil-free and non-comedogenic, like the cleanser and moisturizer. One that fills the bill is the Neutrogena Sheer Zinc Face Dry-Touch Sunscreen with SPF 50, which uses reef-safe zinc oxide to shield the skin.
Next, consider adding an exfoliating step into your routine twice a week to encourage healthy skin-cell turnover. Tiernan recommends looking for a product with alpha hydroxy acids (AHAs) or beta hydroxy acids (BHAs) that chemically exfoliate the skin, rather than a physical scrub. AHAs are thought to work better for pigmentation issues, while BHAs break up blackhead- or whitehead-causing bacteria and impurities. Both of these acid types prevent the buildup of dead skin cells and can thwart milia—what you choose should be based on personal preference or the advice of a dermatologist. If your main objective is light exfoliation that’ll ward off milia and keep your skin looking bright, consider an AHA with lactic, glycolic, malic, citric, tartaric, or mandelic acid. One option is The Ordinary’s Lactic Acid 10% + HA that uses Tasmanian pepperberry to combat any irritation from the exfoliating lactic acid. To prevent milia and blemishes, consider a product that contains salicylic acid, like the top-rated Paula’s Choice BHA Skin Perfecting 2% BHA Liquid Exfoliant that also contains green tea to soothe the skin.
If you frequently deal with milia, you may require a more aggressive regimen with a retinol or retinoid. “These are things that we frequently use in the treatment of acne and they just help the cell-turnover process and I think that, oftentimes, they help with the clearing of milia,” Tiernan says. If you’ve never used a retinoid product before, you can start with retinol, an OTC option, like RoC Retinol Correxion Deep Wrinkle Night Cream. If you already use an OTC retinol and milia persists, a prescription retinoid may better suit your skin.
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