What are milia and what causes them?

Cynthia Bailey, MD|January 31, 2011

 

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 science has figured 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 SMART Profile Brush or a Buf Puf Facial Sponge to gently cleanse 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.

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 afterwards.

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.  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 knows, 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 you can send them to me using the Ask Dr. Bailey form.

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: 

        I too have milia I am 72 years old have been to 5 different dermatologists
   
      I do pick them out with a tweezers and my face is a mess.  I take doxacylcomin

      twice a day, Have the retinol, have tried everything you mentioned to no

      avail. Help

By Janice Morley on 2016 09 25

  Bought ‘Forever Flawless’ which exfoliates 3 layers at a time twice a week
and have new hope

 

By Janice Morley on 2016 09 30

Hello Janice,
Some complexions collect milia like it is treasure! It is indeed frustrating. In my office my nurse uses sterile instruments to extract milia for our patients. It is important milia extraction be done carefully to prevent infection and scarring. Skin care helps to slow the process but control is both preventative and with extraction. Note that any skin damage can lead to milia formation so it is a complex balance. Best wishes. Again, Retinol Night Cream and Glycolic Acid Anti-Wrinkle Face Cream plus Replenix Scrub and the Clarisonic Brush are the mainstays of treatment for skin care in my office for milia reduction.

By Cynthia Bailey on 2016 10 06

I have been told I have Milia inside my eyes.  Have you ever heard of this? Is there anything I can do to get rid of them?

By Oblinger on 2016 10 06

From Dr. Cynthia Bailey M.D.: Milia can form on the eyelid skin. Getting them “in” the eye would be a question for an opthalmologist. The lash line can form milia-like bumps, again that falls in the opthalmology expertise.

By Misha Bailey on 2016 10 10

I am quite a bit older than most of you and have had milia for about 40 years.  I too use a 10x mirror and can’t go without it.  To treat the milia I use Maximum Strength Pan Oxyl 10% Benzoyl Peroxide Acne Foaming Wash 5.5 oz tube. It costs approximately $15.00.  I read about this about 5 years ago in a magazine.  You can also buy the Walgreen’s brand.  If you can’t find it ask the pharmacist as they may have it behind the counter.  This has worked well for me an has kept the milia in control for me.

By Patricia on 2016 10 17

Thank you for sharing your experience with Pan Oxyl. That is a time honored product, around as long as I’ve been in derm! My Foaming Benzoyl Peroxide Cleanser also has 10% and is $14.50 for 8 oz. https://www.drbaileyskincare.com/face/by-condition-1/acne/benzoyl-peroxide-acne-cleanser I also carry an alcohol free lotion in 2.5 and 5 and 10% strength. Sometimes, sensitive complexions can’t tolerate the foaming or higher than 2.5% so this range of products gives people options with benzoyl peroxide. https://www.drbaileyskincare.com/face/by-condition-1/acne/benzoyl-peroxide-acne-treatment-cream

Thank you for sharing and helping me help others suffering from milia. Warm Regards, CBMD

By Cynthia Bailey, MD on 2016 10 25

I have milias all over my scalp.  What can I do to prevent them or get rid of them? If I pick at them they are likely to get inflamed.  The doctor has extracted one or two, but I have too many for that.  Is there a shampoo that is effective?  I haven’t found the one yet.

By Andrea on 2016 11 23

Andrea, doctor’s don’t entirely know why milia form and they are frustratingly common for some people.  The scalp and the face are the two areas most prone in my experience. As mentioned in the post, skin injury and rash are one of the few events we do know that can lead to milia formation so controlling those circumstances are the only real impact we know a person can make. Thus, if a person suffers from dandruff then controlling that rash with Foaming Zinc might help. In my office we manually extract milia and will do as many as a person can tolerate during an appointment. They return for more when they are ready. Milia are annoying and that is how we help.

By Cynthia Bailey, MD on 2016 11 25

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