Have you noticed small white or yellow bumps under your eyelids, or on your nose or cheeks? Technically known as milia, these stubborn bumps are small cysts that form under the skin.
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Milia occurs when dead skin cells “get trapped under the skin and form really hard, little white bumps,” says Neil Alan Fenske, M.D., professor and chair of the department of dermatology at Morsani College of South Florida. Medicine in Tampa. Inside the cyst is keratin, a protein in skin and hair.
Milia can grow up to two millimeters, but are often smaller. And while they can develop in anyone, the bumps are more common in infants.
“About half of newborns have milia, usually on the face,” says Nkanyezi Ferguson, MD, assistant clinical professor of dermatology at Carver College of Medicine, Iowa. “In newborns, milia usually clear up on their own within four weeks without the need for treatment and without scarring.”
Adult mili are similar but can last longer. In either case, milia are essentially harmless and usually do not require treatment.
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So what causes milia?
No one knows what causes milia or why some people get bumps more than others. Some reports suggest that using harsh or heavy skin products can cause milia.
Milia can be associated with other medical conditions such as burns, rashes, skin trauma, even tattoos, certain medications, or skin trauma. The bumps that occur in these cases are called “secondary milia” and can appear anywhere on your body.
Dr. Ferguson says: “Millia occurs after a blistering process or superficial ulceration due to trauma or procedure.”
These include rare blistering diseases such as porphyria cutaneous tarda or epidermolysis bullosa. “When the blister heals, little scraps [of skin] get stuck there,” says Dr. Fenske.
A similar process occurs with some sunburns. “We’ll see some milia when the skin peels off and small pieces of the epidermis are trapped,” he explains.
Drugs that cause milia include tyrosine kinase inhibitors and potent corticosteroids that treat a variety of cancers.
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How to get rid of milia
Milia do not require treatment and usually disappear within a few weeks to months. But you may want to get rid of bumps quickly for cosmetic reasons. Do not treat milia (a single form of milia) as you would any other skin disorder. It will only make it worse.
The only surefire way to get rid of milia is to see a dermatologist for extractions.
“They really stick to the skin,” says Michelle S. Green, MD, a dermatologist at Lenox Hill Hospital in New York City. “Nothing will remove them except extraction.”
Smart skin care is important, but not getting rid of milia. Not cleaning properly doesn’t cause milia, says Dr. Fenske.
Steaming your face, such as taking a very hot shower in the bathroom, helps soften the outer surface of the skin so the dermatologist can remove them more easily. “Steaming opens pores but doesn’t get rid of milia,” says Dr. Green.
Some people try home remedies like rose water (supposed to be anti-inflammatory) or Manuka honey (supposed to be anti-inflammatory and antibacterial), but there’s no evidence that these help. The same goes for exfoliating and chemical peels. In fact, they can make milia worse.
There is some evidence that vitamin A-based medications, called retinoids, may help. “If you have a lot of milia, your doctor may recommend using a topical retinoid to reduce the number and make it easier to remove,” says Dr. Ferguson.
When to see a dermatologist?
If you really want to get rid of milia, see a dermatologist.
“Milia are harmless and require no treatment,” Dr. Ferguson said. “If you’re concerned about appearance, a dermatologist can help diagnose milia. A dermatologist can help remove milia that are irritating or cosmetically bothersome.
It’s easy to remove in a dermatologist’s office, adds Dr. Fenske. “They’re very shallow, but you can’t really squeeze them. We just take a little blade, make a little cut in it, and throw it.”