What are milia?
Milia are small, white or whitish cysts on the skin. They are most common in infants and most commonly appear on the face, although they occur in other age groups and on other parts of the body. About 40-50 percent of newborns in the U.S. have milia.
“Milia” is the plural word; one is called a “milium.” A milium is also known as a milk spot or an oil seed.
They do not require treatment. In babies, milia usually do not last longer than a few weeks. People old enough to care about how they look might seek to have them removed.
Symptoms and Causes
What are the different kinds of milia, and what causes them?
- Milia occur when dead skin cells get trapped under the skin and form cysts.
- Neonatal milia are found in about half of all infants. They often appear on or around the nose. They are sometimes confused with “baby acne,” which is not the same thing. Unlike baby acne, milia can be present at birth.
- Primary milia, which often appear on the eyelids, forehead, cheeks or genitals, can occur in children or adults. Primary milia are not associated with damage to the skin. Like neonatal milia, they usually clear up on their own, but it might take a few months.
- Secondary milia happen after the skin is damaged in some way – burns, rashes, blisters, excessive exposure to sunlight. The milia develop as the skin heals. Another name for secondary milia is traumatic milia. They can also be caused by a reaction to a heavy skin cream or ointment.
- Juvenile milia are commonly linked to an inherited disorder. The milia are sometimes present at birth, and sometimes show up later.
- Milia en plaque is an unusual condition that mostly, but not exclusively, affects middle-aged women. The milia are clumped together on a raised patch of skin, usually behind the ears, on an eyelid, or on the cheek or jaw.
- Multiple eruptive milia, another rare form, are groups of milia that appear over weeks or months, usually on the face, upper arms or upper abdomen. They are sometimes itchy.
Diagnosis and Tests
How are milia diagnosed?
Most of the time, and especially if the patient is an infant, a doctor can diagnose milia by just looking at it. If it’s unclear whether the cysts are milia or some other type of skin condition, a skin biopsy can be useful. That’s a test in which a small piece of skin is removed and examined with a microscope.
Management and Treatment
How are milia treated?
Milia usually are not treated, because they are not harmful. Adolescents and adults might be concerned about what milia do to their appearance. In these cases, there are ways that a doctor can remove them. These include medical therapies such as regular application of adapalene gel which is over the counter or tretinoin cream which is a prescription. There are also surgical options which may involve using a needle to puncture the milia and squeezing out the contents, and/or cryotherapy, which is a technique that involves freezing the skin. Milia en plaque can sometimes be successfully treated with medicated creams or an antibiotic called minocycline.
You should not try to squeeze or scrape off milia on your own, as you might do with a pimple. This can scar the skin or cause an infection. But there are things you can do at home that can help:
- Wash your baby’s face every day with warm water and gentle soap. Then dry it very gently. Pat the skin dry, do not rub.
- Do not use lotions or oils that are meant for adults on a baby. Infant skin is too delicate.
- Adults might try an over-the-counter treatment to exfoliate the skin, which means removing dead skin.
- Use sunscreen.
Can milia be prevented?
Most cases of milia cannot be prevented. You can improve your chance of avoiding secondary milia, in particular, if you take steps to protect your skin. Avoiding excessive exposure to the sun, avoiding the use of thick facial creams/ointments, and exfoliating are things that will help.
Outlook / Prognosis
What is the outlook for people with milia?
For babies, milia usually last only a few weeks. They can persist longer in older children and adults. Secondary milia can be permanent. The scarring from improper treatment of milia, such as attempting to squeeze or scrape them off of your own face or your baby’s, can also be permanent.
When should I seek medical help for milia?
Since milia affect your appearance, but not your health, the urgency of the situation depends on how much it’s bothering you. Adults with milia might want to see a dermatologist if exfoliating treatments at home do not seem to be helping.
Babies usually see doctors quite often on a schedule. If your baby’s milia seem to be persisting or if you are concerned for another reason, ask the doctor at your next visit.