A Dermatologist’s Comprehensive Guide on Milia Treatment

They may be small, but we definitely do not want these small, pesky bumps around. Milia, sometimes called ‘milk spot’ or ‘oilseed, are tiny white bumps that are benign, but hard to remove. You may have attempted to squeeze it out, given that they

can be cosmetically unappealing, but that would only worsen it.

If you are hoping to know the causes of those tiny bumps under your eyes, and how to get rid of it, read on.

Understanding what is milia – the white bumps under your eyes

Milia are keratin-filled bumps of 1-3 mm in diameter, arising from the outermost layer of the skin. Keratin is a structural protein that makes up your hair, nails and skin.

They are classified into primary and secondary.

What causes milia?

Primary milia is the most common, occurring spontaneously without a known stimulus. Secondary ones are induced by various stimuli, typically when the skin undergoes some form of trauma. This could be dermabrasion, physical trauma e.g. x-rays, inflammatory skin diseases e.g. acne or use of topical or systemic drugs.

Primary milia are connected to the sheath of our hair follicles, near our oil glands. Secondary milia connect to our sweat glands, rarely to hair follicles or the outermost skin layer. They are formed when there is an obstruction of the hair follicles or sweat glands.

Primary milia

Such forms are common in newborns, typically found on the face or scalp. They tend to disappear within weeks. In adults, benign primary milia occur spontaneously, often randomly distributed across cheeks and eyelids, and sometimes at the genitalia. While milia found on newborns go away in time, those that develop later in life tend to persist.

Rarer forms include milia en plaque, where multiple keratin-filled bumps are found in a cluster. It occurs without any apparent trigger and can arise spontaneously on healthy skin of predisposed individuals. Affected areas are often reddish, found under the eyes, on the ears, head or neck.

Multiple eruptive milia have a wider distribution than simple primary ones. It may be spontaneous or an inherited genetic condition. The bumps can be found distributed over the face, neck, upper chest, back and arms. It often numbers in the hundreds and can develop over a period of weeks to months.

Secondary milia

Secondary milia occur anywhere following traumatic stimuli after the skin is damaged in some way. Medications that may trigger them include topical steroids, penicillamine, benoxaprofen and cyclosporine. Other conditions can include contact dermatitis, skin grafts, second-degree burns and radiotherapy. In children, superficial abrasions can also lead to secondary milia.

Treating milia: can it be done at home or by a dermatologist?

Milia is benign and does not have any symptoms, thus treatments are only necessary if requested by the patient. However, all treatments must be recommended by your dermatologist.

• Evacuation: For individual milium, the most effective way is to nick it with a scalpel blade, followed by applying pressure with a blunt edge. It is important to only have it done at a dermatologist’s office, as it may result in scarring when done without professional expertise. Any puncture of the skin may also cause infection.
• Laser therapy: CO2 laser ablation can treat individual or multiple bumps with minimal complications or recurrences
• Oral prescription: Tretinoin or minocycline is often prescribed.
• Microdermabrasion: A skin-resurfacing procedure to help gently sand the outer skin layer, causing cell turnover. Skin that grows back is smoother.
• Electrolysis: Current is applied through a tiny needle on the milium, piercing through the keratin-filled bump. The contents of the milium are then soften, thus easy to remove.

Patients should not attempt extraction at home on themselves. While the bumps alone do not have any side effects, improper technique can cause skin trauma, leading to scarring or injury. If you would like to remove such bumps professionally, do consult an accredited dermatologist who will be able to assist with comprehensive management including post-treatment skincare to prevent recurrence.