What are milia and what causes them?

Dermatologist Dr. Cynthia Bailey answers your questions about skin care and skin problems

Dr. Bailey,

I am 59 yrs old and prone to milia.  I also have sensitive skin, rosacea, and recently seborrhetic dermatitis (facial dandruff).  Would you please explain what causes milia, and the best way to prevent them.

I suspect that I get more milia when I’ve been using suncreens w/ zinc.  Is this possible, or am I off-base?

My best defense in the past has been Retin-A, but my skin has been more sensitive lately.

Thank you, Susan

Dear Susan,

Milia are small cysts that are actually little pockets formed from your top skin layer called the epidermis.  They look like pinpoint hard white cysts, sometimes with a blackhead like opening to the skin surface.  When a person has a lot of them the skin takes on a cobbled appearance.

The white material in a milium (single for milia) is made up of cells from the dead skin layer called the stratum corneum.  Unlike a sebaceous cyst (also called an epidermal inclusion cyst), milia do not form from a pore; they are just a pocket of normal skin that somehow indented, sealed over and the dead cells got trapped.

Milia usually form spontaneously, not for any reason that we ever figure out.  They usually occur on the face, but I’ve seen them on the neck, scalp, chest, back and even the back of the hands.   Interestingly the changes in skin that happen from years of chronic sun damage seem to promote milia formation for predisposed people.  Milia also tend to occur after a rash or skin injury.  Rosacea and facial dandruff (seborrheic dermatitis) are rashes that can cause milia to form.  So are the rashes of allergic reactions and irritation from harsh products.

Nothing absolutely prevents milia from forming if you’re prone to them.  Typically we treat milia by keeping the skin exfoliated, but the exfoliation must be done without irritating the skin. Skin care products that create exfoliation like Retin A (tretinoin) and glycolic acid usually help reduce the size and number of milia.  Regular facials and mild chemical peels often help.  In my experience, using the Clarisonic Plus Sonic Brush or a Buf Puf Facial Sponge to gently cleans your skin can help too.  In my dermatology practice, I help patients utilize some combination of these options that doesn’t irritate their skin because I find combination therapy the most effective means of controlling milia.

Click here to see the Clarisonic Plus Sonic Brush System

Existing milia that don’t respond to exfoliating skin care can be manually extracted in a medical office. The skin over the milia needs to be lanced with a sterile instrument and then the small deposit of dead skin can be gently extracted.  We use a tool called a comedone extractor to do this.  In my office this is a medical procedure because any puncture of the skin creates the risk of infections.  Also, the puncture and subsequent pressure with the comedone extractor creates a small wound, and as with any wound there is a very small chance of leaving a mark or scar afterwords.

Susan, I was not able to find any medical reference connecting milia formation with zinc oxide sunscreen.  We know that sun damaged skin is prone to milia and so I actually think that makes zinc oxide sunscreen helpful for preventing milia in some sense.  I believe that micronized zinc oxide mineral sunscreens provide the best sun protection for the skin and are therefore important for preventing sun damage. Who know, using a zinc oxide sunscreen every day may ultimately reduce a person’s lifetime risk of being a ‘milia former’.

Warm Regards,

Cynthia Bailey MD, Dermatologist

If you have questions about skin care or skin health please send them to me using the Contact Dr. Bailey button at the top of the page.

Disclaimer: Please realize that availing yourself of the opportunity to submit and receive answers to your questions from Dr. Bailey does not confer a doctor/patient relationship with Dr. Bailey. The information provided by Dr. Bailey is general health information inspired by your question. It should not be a substitute for obtaining medical advice from your physician and is not intended to diagnose or treat any specific medical problem (and is not an extension of the care Dr. Bailey has provided in her office for existing patients of her practice). Never ignore your own doctor’s advice because of something you read here; this information is for general informational purpose only.

If you found this helpful, you may also want to read:

How To Unclog Your Clogged Pores

Start The Best Anti Aging Skin Care Now and See Results In The New Year

Facial Skin Care For Problem Skin With Facial Seborrhea, Rosacea and Clogged Pores

Cracked, Dry, Brittle and Splitting Fingernails; Dermatologist’s Tips

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5 Responses to “What are milia and what causes them?”

  1. Martha February 1, 2011 at 6:12 am #

    Thanks so much, Dr. Bailey.

    I have recently developed cystic acne that my dermatologist says is a result of menopause. She says the decline in estrogen has caused the androgen (I think that’s what she said) to be more prominent.

    I’ve started taking spironolactone in addition to the minocycline I started for a really terrible outbreak of regular acne from probably stress. The spironolactone has helped, but it hasn’t solved the problem, and I feel weak and not well since taking it.

    Are there other options I could discuss with my doctor? I’m not sure I can keep up with the spironolactone. She suggested Accutane as a last resort, but I would prefer not to do that. My understanding is that it kills oil production. My skin has gotten significantly less oily over the years, and now is not oily. I may need the moisture t as I age.

    We both prefer not to use medication, and for several years I have managed without anything but topical medication. I have a job that requires a professional appearance, and clear skin is a minimum, so I have to do something. Any suggestions would be appreciated. Thank you, Martha
    PS I love your products.

  2. Cynthia Bailey MD February 1, 2011 at 7:14 am #

    Hello Martha,
    I am sorry to hear that you have such an aggressive and stubborn acne problem. Look at my post on the other pustular acne-like problems that masquerade as acne. I see these fairly commonly, especially in patients who have been on oral or topical acne antibiotics. The link is http://www.drbaileyskincare.com/blog/common-reasons-why-your-acne-treatment-might-not-be-working-new-ideas-to-treat-your-acne-from-a-dermatologist/ Bring the post in to your doctor. It sounds like your lesions are large so that suggests the staph or gram negative over the pityrosporum folliculitis but she will have to see if any of those are possible explainations. I have another post on pityrosporum folliculitis that describes the type of lesions in that process. The link is http://www.drbaileyskincare.com/blog/pityrosporum-folliculitis-acne-could-this-be-why-your-acne-won%E2%80%99t-go-away/ I’m glad that your dermatologist is trying really hard for you and also that she does not like having to keep patients on long term oral therapy.

    Best wishes, Cynthia Bailey MD, Dermatologist

  3. Martha February 2, 2011 at 11:26 am #

    Thanks, Dr. Bailey.

  4. Christina February 2, 2011 at 4:02 pm #

    Hi Dr. Bailey,

    I’m in my mid-twenties and have used Dove soap my whole life. Ever since I changed to cream cleansers and overloaded on harsh anti-aging products the past year, my skin has gone from dry and clear to oily and sensitive with acne. I’m sure stress and hormones are involved too. I feel like after all the improper exfoliation my skin seems thinner on my cheeks, and when I smile more red looking – it also can get blotchy. Can the skin recover from this?

    I just bought the Noble Formula Bar Soap and Topix CF Cream, as well as the Glycolix Elite Facial Cream. I only apply the creams to my cheeks as I have an extremely oily t-zone. Is that okay? When I looked at Noble Formula website, it said that ” Noble Formula is a suspension of pyrithione zinc, sodium lauryl sulfate, isopropyl myristate and alcohol.”

    Would the SLS and the alcohol cause problems for those with sensitive skin? Or is it an insignificant amount?

    Thanks so much!!

    P.S. I also started the Alkaline Diet and it’s great!

  5. Cynthia Bailey MD February 2, 2011 at 6:05 pm #

    Hello Christina,
    The skin is resilient and will recover after an insult or injury (eg. a harsh skin care product) once that insult is stopped. It can take a number of months however; it takes at least several months for new cells to rebuild a normal epidermis and dead cell layer after the inflammation subsides. This is what gives us our normal skin barrier strength. During the recovery time I recommend that my patients use only gentle products to help the skin heal as quickly as possible while it is still vulnerable. Occasionally little ‘broken’ capillaries are left behind after a severe irritation or injury unfortunately. As you can see in my blog post on broken capillaries, there are other reasons for facial capillaries though http://www.drbaileyskincare.com/blog/why-you-might-have-broken-facial-capillaries/

    I would recommend that you see a good dermatologist for a diagnosis because rosacea can start showing up in the 20’s and some of what you describe makes me wonder about that.

    The Noble Zinc Bar that I sell is a unique product and it only has the pyrithione zinc, olive oil infused with calendula, oats and emu oil. I don’t know where you found the ingredients for Noble Formula, but they are not in the bar that I sell.

    I’m also glad that you like the Alkaline Diet, it’s a big help for me too!

    Warm Regards, Cynthia Bailey MD