Milia: Causes, Symptoms & How to Treat Them

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What is Milia? Where Does it Form?

Milia are tiny, white bumps that develop on the skin’s surface. 

They result from keratin trapped underneath the surface of the skin. Keratin is a protein that makes up your hair, nails, and skin.

Unlike whiteheads, which are made of pus, milia are not a symptom of clogged pores.

The bumps are usually found on the face, lips, eyelids, and cheeks. They may also develop on other areas of the body like the torso or genitalia.

Milia are small, dome-shaped bumps. They are typically white or yellow.1

Types of Milia 

Milia is classified based on the age the bumps develop and the underlying cause. There are two types of milia: primary and secondary.

Primary milia develop directly from trapped keratin. These cysts usually form on the faces of infants or adults. 

Secondary milia look similar to primary milia. However, they develop after something blocks the ducts leading to the skin’s surface. This blockage can be caused by an injury, blister, or burn.

Neonatal milia

Neonatal milia are primary milia. It occurs in newborns and heals within a few weeks. The bumps are usually seen on the face, scalp, and upper torso.

Juvenile milia

Rare genetic disorders that affect the skin can result in juvenile milia.

These conditions include:

  • Nevoid basal cell carcinoma syndrome (NBCCS), which can lead to basal cell carcinoma (BCC)
  • Pachyonychia congenita. This condition may lead to thick or abnormally shaped nails.
  • Gardner’s syndrome. This rare genetic disorder may progress to colon cancer over time.
  • Bazex-Dupré-Christol syndrome. This syndrome affects hair growth and the body’s ability to sweat.

Milia en plaque

This condition is linked to genetic or autoimmune skin conditions, like discoid lupus or lichen planus. 

Milia en plaque can affect the eyelids, ears, jaw, or cheeks. The bumps can be several centimeters in diameter.

Milia en plaque is commonly seen in middle-aged females, but it can develop in adults or children of any age or sex.

Multiple eruptive milia

This milia form consists of itchy areas that develop on the face, upper arms, and torso. These cysts often occur over a period ranging from a few weeks to a few months.

Traumatic milia

These cysts appear where injury to the skin has occurred, such as severe burns and rashes. 

The cysts may become irritated, making them appear red along the edges and white in the middle.

Milia linked with drugs or products

Steroid creams can result in milia on the skin where the cream is applied. But this is rare. 

Some ingredients in makeup products and skincare items can also cause milia in some people.

What Causes Milia? Who is at Risk?

Newborn babies often have milia. They are also common in older children. 

Adults may also develop milia, especially on the cheeks or below the eyes.

However, the causes of milia differ from those in newborns compared to older children and adults.

Newborns

The cause of milia in newborns is unknown. Milia in newborns is often mistaken for baby acne, which occurs from hormones from the mother.

Unlike baby acne, milia do not lead to inflammation or swelling

Infants with milia are typically born with it. Baby acne does not develop until two to four weeks after birth.

Older children and adults

Milia is typically connected to skin damage in older children and adults.

Damage to the skin may include:

  • Blistering due to a skin condition like epidermolysis bullosa, cicatricial pemphigoid, or porphyria cutanea tarda
  • Blistering injuries like poison ivy burns
  • Long-term sun damage
  • Long-term use of steroid creams
  • Skin resurfacing procedures like dermabrasion or laser resurfacing

Milia can also occur if the skin loses its natural ability to exfoliate as it ages.

Are Milia Painful? 

Milia are not usually itchy or painful but they may cause discomfort. Rough clothing or sheets may lead milia to appear irritated and red. 

How to Get Rid of Milia 

While milia are not a cause for concern, some people prefer to remove them.

Professional Treatments

A dermatologist may be able to treat milia under your eyes with one of the following procedures:

Deroofing

During deroofing, a dermatologist uses a sterilized needle to remove the milia from under your eyes.

Cryotherapy

In cryotherapy, liquid nitrogen freezes the milia and destroys it. 

This procedure is not always recommended for the area close to your eyes. Talk with your doctor or dermatologist to determine if this treatment is suitable for you.

Laser ablation

During laser ablation, a small laser focuses on the milia to open the tiny cysts to remove the keratin buildup underneath the skin.

Home Remedies 

There are also various home remedies to help clear up milia. 

Exfoliating

Try cleaning and exfoliating the skin. Milia develop under the eyes due to an excess of keratin. 

By gently exfoliating the area with a warm washcloth, you may remove some dead skin cells and help trapped keratin rise to the surface.

Steaming

You can also try steaming your skin. Spending some time in the bathroom with the door closed and a hot shower running can provide an easy at-home steam treatment for your skin.

Rosewater and manuka honey

Rosewater and manuka honey may also help. Consider spritzing a bit of rosewater or applying a manuka honey mask on your face. 

The anti-inflammatory properties in roses and honey can help clear up milia.

Over-the-counter products

You can also buy over-the-counter products to heal milia under your eyes. These include:

  • Topical alpha hydroxy acids such as glycolic acid and lactic acid can promote healthy skin. You can find these ingredients in products like face toners, masks, and skin peels. 
  • Salicylic acid treatments also work well to remove dead cells. This may help release keratin trapped between skin layers. Salicylic acid is present in exfoliating creams and cleansers.
  • Over-the-counter topical retinoids also promote cell turnover and reduce the stickiness of cells in your pores. These ingredients help old skin cells and trapped toxins rise to the skin’s surface.

Before purchasing products to treat milia, read the label to ensure it is safe to use under the eyes. Since this area is very sensitive, you may need to choose products specifically designed and marketed for under the eyes.

When to See a Doctor

Milia do not need to be treated. They usually clear up within a few weeks to months. However, you may want to get rid of them sooner for cosmetic reasons.2

If you want to get rid of milia, see a doctor or dermatologist. They can help make the diagnosis of milia if you are concerned about the appearance. 

A doctor or dermatologist can also help remove milia if they bother you cosmetically or are irritated.

How Long Does it Take for Milia to Go Away?

Milia in children usually clear up within a few weeks

In adults, milia typically take a few months to heal, depending on the underlying cause.

However, if your milia do not improve within a few weeks, you may want to check in with your doctor. They can make sure it is not another skin condition.

What Not to Do if You Have Milia 

If you have milia, avoid picking or poking at the small cysts. Leaving milia alone helps them heal faster.

If you pick the bumps to the point they become irritated, the milia may lead to infection and scarring.

Milia Prevention Tips

If you keep experiencing milia under your eyes, consider adjusting your skincare routine.

You should regularly clean, exfoliate, and moisturize your skin. 

Too much exfoliation can irritate your skin. Gentle exfoliation under the eyes can promote new skin cells to come to the surface and loosen trapped keratin.

If you are prone to milia, choose oil-free soaps and cleansers.

You can also consider using a night serum containing vitamin E or topical vitamin A approved for under-eye use. 

As you age, your body loses some of its ability to exfoliate dry skin. Serums can retain moisture and encourage cell growth while you sleep.

Also, make sure you are getting enough of the vitamins and nutrients that make your skin healthy.

If you are concerned that you are not getting enough vitamins from your diet, here are some oral supplements you can try:

  • Vitamin E
  • Vitamin B-3 (niacin)
  • B-complex vitamins

The Food and Drug Administration does not monitor or regulate supplements as they do drugs. 

It is essential that you speak with your doctor for medical advice before trying supplements. Some may interfere with the medications you are currently taking.

Resources
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Milia, Mayo Clinic, June 2020

What Are Milia—And How Do You Get Rid Of Them?, USF Health, Dermatology & Cutaneous Surgery, University of South Florida, August 2018

Gallardo Avila PP, Mendez MD. Milia. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan

Berk, David R, and Susan J Bayliss. “Milia: a review and classification.” Journal of the American Academy of Dermatology vol. 59,6 (2008): 1050-63

Terui, Hitoshi MD; Hashimoto, Akira MD; Yamasaki, Kenshi MD, PhD; Aiba, Setsuya MD, PhD Milia En Plaque as a Distinct Follicular Hamartoma With Cystic Trichoepitheliomatous Features, The American Journal of Dermatopathology: March 2016 - Volume 38 - Issue 3 - p 212-217

Avhad, Ganesh et al. “Milia en plaque.” Indian dermatology online journal vol. 5,4 (2014): 550-1. doi:10.4103/2229-5178.142573

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