Milia is a skin condition characterized by small cysts or keratin papules. They can be white or yellow and affect the most superficial layer of the skin. This skin change is caused by excessive sun exposure, use of petroleum-based products on the skin. It can also appear in over-heated babies.
Generally milia appear in regions of the face, like the nose, eyes, cheeks and behind the ear. They can also appear on the neck, hands, back, and in rare cases, the scalp, inside the mouth and around the genitals. Milia papules can cause itchiness, although other symptoms generally do not appear in most cases, nor do they cause skin problems.
A consult with a dermatologist can help to confirm a diagnosis, rule out other skin lesions like an allergic irritation, and remove these small cysts. The dermatologist will assess you to determine the most appropriate treatment approach.
The cause of milia is not completely known, but it is believed that they arise due to a breakdown of elastic fibers of the skin and of cells that produce keratin. This breakdown may be triggered by excessive UV exposure from the sun. In newborn babies, milia is a common condition that can occur after birth or due to over-heating. With babies, these papules tend to resolve on their own.
Some types of milia can appear on the skin following a burn that has blistered, with use of certain products (specifically those that contain hydroquinone, corticoids or petroleum) and as a result of other health conditions like pemphigus, porphyria, lupus erythemetosus and lichen planus.
Main signs and symptoms
Milia is a skin alteration that is characterized by visible, pearl-like papules. They may or may not be itchy and also have the following characteristics:
- Similar to a cyst
- About 1 to 3 mm in size
- Clear or yellow-like color
These papules are filled with a gelatinous fluid called keratin, which is a naturally-occurring skin protein. They occur mainly on the nose, forehead, cheeks, eyelids or behind the ears, but can also occur in the genital area or roof of the mouth.
There are different types of milia that are defined by their cause and location. Some types include:
- Neonatal milia: which occur in about half of newborn babies. It is characterized by small skin cysts that resolve over time. They occur on the nose, cheeks and even inside the mouth.
- Primary milia: which occur in adults. It is characterized by visible, small papules that are found on the eyelids, cheeks, forehead, and in rare cases, in the genital areas.
- Juvenile milia: this type is associated with Rombo syndrome, Gorlin syndrome, Bazex-Dupré-Christol syndrome, paronychia, Gardner syndrome, and other genetic conditions.
- Milia en plaque: which occurs when various milia cysts emerge in the same place, forming a plaque of inflammation on the skin. It usually occurs behind the ear or cheek.
- Traumatic milia: which occurs when milia papules appear in skin areas that are healing or scarring, or when burns result in blisters.
In addition, the prolonged use of skin products, like creams, ointments, petroleum-based make-up, lanolin, corticoides, and hydroquinones can lead to the emergence of milia.
How to get rid of it
To remove the papules cause by milia, it is important to see a dermatologist. They are professionally trained to remove the milia with needles, and may also indicate other treatment methods, which can include:
1. Skin cleansing
The best way to remove milia that are small in size and quantity is by doing a deep-cleaning facial by a trained esthetician. This will naturally rupture the papules and eliminate them. You should not remove the milia cysts as if they were pimples or warts, nor should you attempt to cut them with a needle at home, as you can increase your risk of wounds and infection (which can worsen the milia).
You should also maintain daily skin cleansing habits, like washing your skin with warm water and oil-controlling face wash, and using sunblock daily. These can greatly reduce the appearance of milia as well as prevent more from appearing.
2. Ointments and medication
The doctor may also recommend antibiotic ointments like bacitran or neomycin if a skin infection is also apparent with the milia. Other creams that are based in retinoids or retinoic acid can also help to eliminate the milia cysts.
Medications are rarely prescribed for treatment of milia. However, some antibiotics like minocycline and be recommended by the doctor when skin lesions lead to serious infections with skin redness and swelling. In some cases, the doctor can also indicate later treatment or cryotherapy.
Treatment of milia in babies
White milia spots are common in newborn babied due to fat retention in the skin. They usually disappear within a few days without any specific treatment.
In babies, milia generally appear in the summer or on very hot days within the first weeks of the baby's life. They can also emerge with a fever. When sweat cannot pass through pores, like in the nose or cheeks, a blister-like papule can emerge. It is usually fluid-filled and rupture easily.