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

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Chances are you’ve had a few of those little white bumps under the skin bumps on your face, which can crop up especially by the eye area. Perhaps you weren’t aware of them (some 50 per cent of newborns have milia) 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 milia and why they’re rarely something to worry about.

What are milia?

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

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

"Trapped" sounds a bit alarming, but let us reassure you that…

Milia aren’t dangerous

Milia are an aesthetic issue rather than a cause for concern - they aren’t indicative of anything else to worry about, reassures Pam Marshall, clinical aesthetician and co-founder of Mortar & Milk.  Dr Spierings emphasises that they’re benign 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

There’s no consensus on this one, but everything from skin trauma such as microneedling  to sun damage to overly 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 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.”

They can also be caused by certain prescription creams such as topical steroids and anti-pigmentation ingredient hydroquinone.  says Dr Spierings.

She notes that milia might also originate in the hair follicles of fine vellus hair or peach fuzz , that everyone has on their face to varying degrees.

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 develop as the skin heals after an injury, which can include aesthetic treatments such as micro-needling that work on the principle of wounding to heal. Burns and blistering skin diseases can cause them too, says Dr Spierings. There's also a form of milia known as colloid milia is associated with excessive sun exposure, she adds.

Whatever your milia trigger, you’re probably wondering if there’s anything you can do to get rid of them.

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. 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 milia 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.”

Should you pick milia yourself?

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.”

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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