Patients frequently ask about the small hard white bumps on their faces called Milia. Milium is singular. Milia is plural. (Glad I took those Latin classes in school.) These are most common on the face (90%), followed by the scalp (9%), and rarely on other parts of the body (1%).
Why do milia occur? Milia are formed when the pore closes off leading to the accumulation of a “pearl” of dead skin in the pouch. They are like a very small cyst. The “pearl” of a milium is firm and white as compared to softer contents found in other types of cysts.
Who is most likely to have milia? Milia are seen in all ages including infancy. However, women over 70 are most bothered by these.
How can I reduce milia formation? Nothing is perfect, but here is what I recommend.
1-Make sure all products are non-comedogenic. Milia are seen more often when thick, comedogenic products. Check all labels of products that are applied to the face and make sure they say “non-comedogenic” or “doesn’t clog pores”.
2–Use a retinoid. Using a topical retinoid helps exfoliate dead skin allowing the milia to release. It also stimulates the growth of collagen to support the walls of pores so they are less likely to close off and form a milium.
3-Use a topical chemical exfoliant. Products with glycolic and lactic acid help remove the top layer of dead skin that traps in the milia. Examples would be Skin Better Science AlphaRet, ZO Enzymatic peel. To learn more about Exfoliating or Skin Better Science, read our prior posts.
“I already have a bunch of milia and I’ve tried to squeeze them and poke them with a pen and I can’t get them out.”
Multiple patients every day!
How can I get milia out? Oh, if I had a dime for every time I’ve been asked this question…Generally, I don’t recommend that patients try to remove their own milia. I’ve seen LOTS OF SCARS from where patients try to do their own surgery. Even when I try to do one in the mirror of my bathroom, it’s not so easy. And DEFINITELY don’t let a random person remove them during a facial.
What can be done in the dermatologist’s office? My treatment methods of milia have evolved over the years. Treating milia is considered cosmetic and not covered by insurance, but I try to make it very affordable.
1-Nick and extract. This is the old-fashioned way of doing it. The milium is nicked with a sharp razor blade. This is the hard part because sometimes they sit very deep. Young ears can hear the tip of the razor blade hit the “pearl”. Then, the milium is extracted using a comedone extractor.
2-Electrodessication. This is my favorite way. I first started doing this on eyelids and places that I couldn’t press hard enough to extract. Now, I do it this way 90% of the time. Electrodessication involves using a cautery tip to very lightly burn the spots. It sounds bad, but it isn’t. It’s really fast. Treated spots are usually shed within 7-10 days.
3-Microneedling. When I first started doing microneedling, oh the joy! Microneedling is a treatment done on the whole face for antiaging, acne scarring, and more. An extra treat is that often the milia will just pop right out during the treatment. It is so satisfying. I recommend this more often for patients with hundreds of milia.
Milia are very common and quite a nuisance for some patients. Hopefully, this article will help you understand more, give you tips to avoid them, and give you the courage to ask about having them removed in the office.
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