Frequently confused with whiteheads, milia are harmless cysts located just beneath the skin, manifesting as small white bumps primarily on the nose, cheeks, forehead, and around the eyes. Unlike whiteheads—caused by clogged pores filled with dead skin cells, bacteria, and sebum—milia arise from a buildup of keratin, a protein that normally exists in the outer layer of the skin. When keratin hardens and becomes trapped, milia form.

There are two main types of milia: primary and secondary. Primary milia are the most common form and can occur in both newborns and adults, often resolving on their own within a few months. In contrast, secondary milia develop as a result of skin trauma, such as injuries from chemical peels or infections, and can persist longer.

What causes milia?

Milia can affect anyone, regardless of age or skin type, although certain factors may increase susceptibility:

• Poor hygiene
• Use of heavy, oil-based makeup and skincare products that can block pores
• Lack of sleep
• Existing skin conditions, such as dandruff or rosacea
• Prolonged use of steroid medications

How to treat milia

While milia are not medically concerning and typically do not cause pain, many seek treatment, especially when they appear in noticeable areas. It’s crucial to advise clients against attempting to squeeze or remove milia themselves, particularly around delicate areas like the eyes, as this can lead to skin damage and scarring.

If the client have lots of milia, they’ve hung around even after trying the below treatments, or they’re in a spot that’s hard for you to treat, it’s best to refer them to a dermatologist.

Over-the-counter treatments

For those with just a few isolated milia, over-the-counter (OTC) exfoliating products may be a helpful first step. Options include:

• Salicylic acid
• Glycolic acid
• A topical acne cream

If milia are extensive, persistent despite the use of OTC treatments, or found in hard-to-reach areas (such as the eyelids), consulting a dermatologist is advisable.

Manual extraction

The most effective way to remove milia is through manual extraction performed by a qualified professional. This involves creating a small opening in the skin with a surgical blade and gently removing the keratin plug. This process is typically painless, with most patients experiencing only a slight prick, and results are visible immediately.

Prescription medications

You can refer clients to a dermatologist who may prescribe topical retinoids to help eliminate milia. These medications are more effective at exfoliating the skin than over-the-counter alternatives and can loosen keratin plugs, promoting their elimination.

Cryotherapy

This procedure involves applying liquid nitrogen to the skin to freeze and remove milia, commonly executed in dermatology practices.

Laser resurfacing

This technique utilises targeted laser beams to eliminate damaged skin layers. It is highly precise and typically does not cause hyperpigmentation.

Chemical peels

Superficial or mild chemical peels may be used to remove milia. However, not all chemical peels are advised for milia removal. Medium and deep chemical peels can actually cause milia as a side effect. Superficial chemical peels may involve the use of some of the same ingredients in OTC products including glycolic acid and salicylic acid.

Tips for managing milia

Encouraging better skincare practices can be beneficial for clients dealing with persistent milia. Here are some practical tips:

Double cleanse: Start with an oil or balm-based cleanser in the evening to thoroughly remove build-up, followed by a gel or milk cleanser to clear out pores.

Regular exfoliation: Recommend using a gentle chemical exfoliant (AHA or BHA) a few times weekly, applying it directly on areas prone to milia.

Targeted eye creams: Since milia are common around the eyes, suggest using specific creams or serums formulated for this delicate area, ensuring they are lightweight.

Non-comedogenic products: Advise those prone to milia to switch to oil-free and non-comedogenic skincare and makeup products to prevent pore blockage.

Low-dose retinol: Encourage the incorporation of retinol into their routine to promote cell turnover and minimise the accumulation of dead skin cells.

Sun protection: Emphasise the importance of daily application of a broad-spectrum SPF50 to protect the skin from UV damage, which can reduce the risk of milia development.