Do you Have Milia?
Dermatologist Dr. Cynthia Bailey answers your questions about what causes milia and how to treat them. 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
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.
Did you know that milia do not form from a pore?
Milia 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.
- The changes in skin that occur due to 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.
How do you treat and prevent milia?
- 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 chemical exfoliation, such as Retin A (tretinoin) , retinol, and glycolic acid, usually help reduce the size and number of milia. These also help to reverse the signs of skin aging. Glycolic acid is often not tolerated by complexions prone to seborrhea and rosacea. Retinol can be tricky too but usually is more successful.
- Regular facials with microdermabrasion or mild chemical peels often help.
- Using the Clarisonic Brush System or a facial exfoliating sponge to gently clean and exfoliate 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.
- In this procedure, 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.