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Skin

Thanks a milia - what you need to know about white bumps on your skin

May 15th 2019 / Anna Hunter / 0 comment

milia.jpg

They crop up around the eyes, nose and cheeks in particular and can be seriously stubborn to treat. Here are the ‘dos and don’ts’ of milia…

You may not be au fait with the term ‘milia’ but chances are you’ve had a few of those little under the skin bumps in your lifetime. Perhaps you weren’t aware of them (some 50 per cent of newborns have milia on their skin) or maybe they’re driving you nuts currently, but before you go on a skin picking spree (DO NOT), here’s exactly what’s up with those little white bumps, what you can do about them and why they’re rarely something to worry about.

What milia are made of

Just what the heck are those bumps? We put it to Dr Natalia Spierings, Medical Director of the UK’s first online dermatologist service Dermatica:

“Milia are one to two millimetre white dermal cysts (fluid-filled sacs) that contain keratin and generally occur on skin on the face, especially on the cheeks and eyelids. Keratin is the protein that makes up the bulk of the top layer of skin, called the epidermis, so milia are essentially a build-up of keratin trapped under the surface of the skin.”

‘Trapped’ sounds a bit alarmist, but let us reassure you that…

Milia aren’t dangerous

Pam Marshall, clinical aesthetician and co-founder of Mortar & Milk, highlights that milia are “an aesthetic issue rather than a cause for concern - they aren’t indicative of anything else to worry about.” Dr Spierings emphasises that they’re “benign (non-cancerous) lesions and do not require treatment unless they are bothersome cosmetically.”

Now that that’s off your mind, onto the why…

Why you’re getting milia

Truth be told, there’s no concrete consensus on this one, but everything from skin trauma to rich skincare and genetics can play a part according to Pam:

“There can be a genetic predisposition to milia but it’s more likely that milia occur as a reaction to either a trauma (like sun damage) or using creams that are too heavy. Most of the time, however, they occur around areas of the body where the skin is thinner (hence undereye milia). This can be made worse by the fact that we tend to sway towards heavy creams in that area too.”

Dr Spierings notes that milia could quite literally have hairy roots:

“There is some evidence to suggest that milia may originate from the outermost cells of the hair bulge of the outer root sheath of a single hair follicle. These are usually vellus hairs – the fine, downy hair that everyone has on their face to varying degrees.”

There’s also more to milia than meets the eye…

“There are various kinds of milia. About half of all newborn babies develop neonatal milia on the face but this tends to disappear a few weeks after birth. In adults, milia can occur as a result of any kind of injury to the skin skin injury and they tend to develop as the skin heals. Examples of ‘injuries’ that can cause this type of milia includes burns, dermabrasion and some blistering skin diseases. They can also be caused by certain prescription creams such as topical steroids and hydroquinone, while a unique form of milia known as colloid milia is associated with excessive sun exposure.”

Whatever your milia trigger, you’re probably wondering if there’s anything you can do to get rid of them. The response to that would be yes...but also no.

How to treat milia

Pam emphasises that ‘leave well alone’ could well be your best bet, as “they can often resolve themselves, especially if you’re younger.” Establishing whether you have a milia trigger could also clear them up by process of elimination, as Dr Spierings stresses:

“The most important aspect of treatment is knowing what is causing them in the first place. In most people, they are probably idiopathic (meaning that there is no known medical cause) but given that there are various types categorised by cause, sometimes if there is an offending agent bringing them about, no treatment will work until that cause is adequately dealt with. A trip to see a consultant dermatologist could help you to get to the crux of what’s causing your millia, and therefore help you to treat the bumps faster and more efficiently.”

As for said treatment, Pam explains that “gentle weekly exfoliation can help to remove them”, while Dr Spierings states that a more invasive method is often followed in professional clinic settings, but don’t try it at home:

“The most common way to get rid of them is by pricking them with a very fine sterile needle and extracting the contents. They can also be destroyed using electrocautery at a low setting with a fine point tip.”

If needles don’t appeal, Dr Spierings states that good old retinol could come to your rescue:

Topical retinoids like tretinoin have been reported to be useful in treating milia if they are extensive on the face. Aside from this, there is no evidence that any other skincare ingredient or formulation is effective in the treatment of milia.”

What not to do

This most definitely is not a PYO situation - Pam confirms that you’re only likely to make matters worse:

“Don't pick at milia as this can lead to infection and ultimately scarring. If they’re getting to you, seek professional help. Unfortunately as they’re for the most part a cosmetic issue it’s unlikely that you can be referred to a dermatologist via the NHS, but if your milia are causing concern it could be worth weighing up the cost of going private.

“If you are predisposed to milia, try to also avoid products containing lots of petrolatum or paraffin as this can exacerbate the problem, and always use a sunscreen as UV damage is a contributor to milia too.”

Basically, what Baz Luhrmann said, and it’s worth bearing in mind that others won’t notice those little white bumps nearly as much as you do. See them as skin quirk rather than an imperfection, and if milia flare-ups are a common occurrence, a little detective work combined with a retinol eye cream could be all it takes to keep the bumps at bay.

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