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Thursday, 12 September 2019 18:54

Understanding Milia: Causes, Treatments, and Best Practices

Written by   Larry Lockhart, R.P.

Milia are benign, superficial, keratin-filled white or yellowish cysts measuring one millimeter to three millimeters in size. These can be just a single cyst (milium) or, more likely, appear in clusters (milia). They are thought to occur when dead skin is lodged in small pockets just below the skin’s surface and not within a pore. Since milia are a cyst, they generally do not become red and inflamed like acne. Many people confuse milia with whiteheads. Milia are not acne. The contents of milia are not fluid like the contents of a pustule. Unlike an acne pimple, the contents are very hard and they are below the skin surface, with no opening.


Milia can form on any race, gender, or age group, but may form more frequently in females. Milia can also form anytime we lose our natural ability to exfoliate, such as aging. They are generally painless and harmless, but they can also be annoying and aesthetically unacceptable.



There are several types of milia. The three most common are:

  • Congenital or Neonatal: Congenital milia are extremely common in neonates, occurring in about half of all newborns, primarily because their skin is still trying to exfoliate on its own. It is usually seen on the face, scalp, and upper body. This type generally disappears in a matter of weeks, with no treatment required.
  • Benign Primary: It usually is seen on the eyelids, forehead, and cheeks of children and, on adults, can also be found on large areas of the upper arms and back. Generally, it clears in several weeks, with no treatment required. Persistent primary milia will require treatment.
  • Secondary: This is identical to primary milia, except it is caused by an external action, such as trauma, deep invasive peels, disease, or even medications, such as hydroquinone, steroid creams, or 5-flourouracil. Sun damage causes the skin to be rough and leathery, which makes it more difficult for dead cells to be shed and easier for milia to form. There is the probability of milia forming any time the skin has suffered on a cellular level.



Current medical research has not determined a prevention method for milia. However, avoiding excessive sun exposure and using at least SPF 30 sunscreen, avoiding oil-based products and thick creams, and exfoliating two to three times per week may be beneficial. A mineral-based sunscreen is preferred because it will reflect the damaging sun rays away from the skin, rather than absorbing the UVA and UVB rays, which can still penetrate the upper layers of the skin to damage and dry that area.



Professional milia treatments in the spa would center on mild exfoliation with enzyme masks, glycolic acid, mandelic acid, or salicylic acid; or, mechanical scrubs could be implemented. Aggressive exfoliation or chemical peels are not required and can irritate the skin, which may lead to more milia formation. Topical retinoid therapy can be initiated in the spa and continued into the home using a therapeutic level of vitamin A to help stimulate fibroblasts to develop healthy tissue. Applying professional products with therapeutic levels of calcium will also speed up cell turnover. Although many times milia will resolve with little or no treatment, it can still take months to see any improvement. In many states, aestheticians cannot remove milia with a lancet because that requires the skin to be pierced.



Homecare treatment would include vitamin A, moisturizers low in oils but high in calcium content, mild alpha hydroxy acids, exfoliating the area regularly with a mild exfoliant such as jojoba beads or enzyme exfoliants, and regularly applying a sunscreen with SPF 30 or above. Because vitamin A can be very drying to the skin, using a product that combines the vitamin A with antioxidants and light moisturizers would be beneficial. Glycolic acid – or, for very dry or sensitive skin, alcohol-free mandelic acid – can be beneficial when used every other night. Clients should not pinch or scrub the area. This may cause more irritation or an infection. Extractions should be limited to professional aestheticians or physicians.


Medical treatment is rarely required, but seeing a physician may be needed if redness or swelling develops. Medical treatment would include prescription retinoids and manual extractions using a small surgical blade.


Larry Lockhart 2019Larry Lockhart, R.P., has been owner and CEO of BiON Skincare since September 2007. He graduated from the University of Nebraska College Of Pharmacy and is well versed in chemicals and how they interact within the body. His expertise is in developing skin care products that use natural ingredients to enhance the health and beauty of the skin.


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