This article looks at different types of milia, their causes, and possible ways to get rid of them.

Milia are small, yellow or white bump-like cysts found under the skin, usually on the face and often found in newborns but they can affect people of any age. They are usually 1 to 2 mm in size.

They form when skin flakes or keratin, a protein, become trapped under the skin.

Milia most often appear on the face, commonly around the eyelids and cheeks, though they can occur anywhere.

1. Home remedies

In most cases, milia will disappear on their own within a few months.

A number of home remedies may help get rid of milia. While no specific remedy has been proven to remove milia quickly, these treatments are mostly low-risk.

For example:

• Clean the affected area daily. Use a mild cleanser to prevent skin irritation.
• Steam open the pores. This can be done by sitting in the bathroom and running a hot shower.
• Exfoliate the area regularly. However, avoid over-exfoliating, as daily exfoliation can irritate the skin.
• Use sunscreen. Non-comedogenic , high UVA&UVB protection sunscreens may be especially helpful.
• Using topical retinoids. Topical retinoids are creams or gels derived from Vitamin A. While they are designed to treat Acne and other skin issues, they are also effective in treating milia.
• Rose, cinnamon and honey Some research claims that these extracts have antibacterial properties that can tackle some skin problems. However, there has been no research on their effectiveness with milia.
• Avoid poking or picking or squeezing milia. While it may be tempting, this interference increases the risk of infection and can lead to scarring.

2. Medical treatments

If milia are causing concern, certain clinical treatments have been used to try and remove them. These include:

• De-roofing. A doctor uses a sterile needle or blade to remove the milia. Do not attempt this at home, as you can run the risk of infection.
• Curettage. A doctor numbs the area, removes the milia, then seals the skin with a hot wire.

• Cryotherapy. The milia are frozen off, often with liquid nitrogen. This can cause blistering or swelling, which should disappear within a few days.
• Minocycline. This oral  antibiotic can be helpful in treating certain types of milia, such as milia en plaque.

All of these treatments carry a risk of scarring, except for minocycline, which has other risks. Since milia themselves do not cause scarring, think carefully before undergoing these treatments.

3. Prevention

It is not always possible to prevent milia, for example, when they occur in newborns.

However, when milia are associated with other skin conditions or injuries, swift treatment may keep them from appearing.

Tips for preventing milia include:

• avoiding excessive exposure to the sun
• avoiding the use of thick creams or oil-based products
• exfoliating between 2 and 3 times a week

Milia can sometimes arise following a chemical peel. It may be possible to prevent their occurrence by applying a topical retinoid before the procedure. However, retinoids can cause dark spots or excessive irritation when used in combination with chemical peels.

4. Types and causes

> Neonatal milia

Milia affect up to 50 percent of all newborns. They usually disappear on their own within a few weeks.

Neonatal milia are often found on the nose, but may appear on the scalp, face, upper trunk, and inside the mouth.

These bumps can be confused with neonatal acne. The white bumps of neonatal acne vary in size, and are often surrounded by redness, while milia are generally uniform in size, with no redness.

Milia may be present from birth, while neonatal acne usually does not appear until 2 weeks after birth.

> Primary milia

Primary milia occur in children and adults. While they may disappear without treatment in a few weeks, they can also last for several months.

Primary milia often appear on the following body parts:

• eyelids
• cheeks
• forehead
• genitals

They may also appear along the nasal crease in young children.

> Milia en plaque

In this condition, multiple milia are clumped together in a broad, flat patch raised above the surrounding skin. This patch or plaque often has a clear and defined border.

Milia en plaque can affect children and adults, particularly middle-aged women. It is usually found on the eyelids, behind the ears, and on the cheek or jaw.

This condition is rare and occasionally associated with other skin issues, including:

• pseudoxanthoma elasticum
• discoid lupus erythematosus
• lichen planus

> Multiple eruptive milia

This rare type of milia involves numerous bumps appearing in the same area over several weeks or months. This is often the only symptom, though the area may also feel itchy.

Multiple eruptive milia tend to appear on the face, upper arms, and upper trunk.

> Traumatic milia

Also known as secondary milia, this condition follows injury to the skin, which may involve:

• a burn
• blistering from a skin condition or allergic reaction
• skin resurfacing procedures, such as dermabrasion or laser resurfacing
• excessive exposure to sunlight

> Milia associated with medication

Certain topical medications, including some steroid creams, may cause milia to appear.

5. Risk factors

Milia carry very few risks.

When milia are associated with another condition or injury, that condition should be treated separately.

It is important that milia are correctly diagnosed. They can be confused with other types of skin conditions, including comedones, miliaria, and other types of cysts.

When milia are a concern, discuss treatment with a specialist.

6. Outlook

Milia tend not to cause long-term problems. The outlook is very good, and most cases will resolve without treatment in several weeks.

The bumps may disappear faster in newborns than in children and adults.

If milia do not disappear within a few weeks, Bard’au & Co will be able to recommend treatment options