Milia are small, hard, white or yellowish bumps, usually 1 to 2mm across, that sit just under the surface of the skin. They're most common around the eyes, on the eyelids, cheeks and nose. They look like whiteheads, so most people try to squeeze them. Nothing comes out, and the skin gets red and sore.
That's because milia aren't spots. They're tiny cysts filled with keratin, the protein that makes up the outer layer of skin. There's no pore opening and no pus, so there's nothing to push out. Knowing that changes how you treat them.
Milia vs whiteheads
| Milia | Whiteheads | |
|---|---|---|
| What's inside | Keratin (a hard, dry protein) | Oil, dead skin and sometimes pus |
| Feel | Hard, like a grain of sand | Soft or slightly raised |
| Opening | No pore opening | A blocked pore |
| Inflammation | Not red or sore unless picked | Can be red and tender |
| Where | Around eyes, eyelids, cheeks, nose | Anywhere you get acne |
| How long | Weeks to months, sometimes longer | Days |
| Squeezing | Doesn't work, damages skin | Not advised, but contents can come out |
If a bump has been there unchanged for weeks, feels hard, and never gets red, it's probably milia.
What causes milia
Doctors divide milia into two broad types.
Primary milia form on their own, from keratin trapped under the skin. They're very common in newborn babies, and usually clear without treatment within a few weeks. In adults they tend to appear around the eyes and cheeks for no obvious reason.
Secondary milia form after the skin has been damaged. Known triggers include:
- Blistering conditions and burns.
- Skin procedures: dermabrasion, laser resurfacing, some chemical peels.
- Long-term use of strong steroid creams on the face.
- Sun damage over many years.
Many people also blame rich eye creams and heavy moisturisers. The evidence for this is mostly anecdotal. Still, if you keep getting milia in one spot where you use a thick cream, switching to a lighter formula there is a reasonable experiment.
How to get rid of milia
Give them time
Milia in babies almost always clear on their own. In adults, some disappear within a few months as the skin naturally sheds. Others stick around for a long time. If they don't bother you, leaving them is a perfectly good option.
Exfoliating skincare
Speeding up the turnover of the outer skin can help the keratin work its way out over time:
- Retinoids. Retinol over the counter, or adapalene and tretinoin on prescription, speed up skin cell turnover. Use them carefully around the eyes, where skin is thin and irritates easily. See what retinol does.
- AHAs. Glycolic or lactic acid used a few times a week loosen dead skin on the surface. More in what AHAs do.
Be realistic: these work slowly, over weeks to months, and on established milia they may not be enough. They're more useful for preventing new ones.
Professional removal
The quickest and most reliable fix is to have them removed. A dermatologist, a GP who does minor procedures, or a trained aesthetic practitioner makes a tiny nick in the skin over the milium with a sterile blade or needle and gently presses the keratin out. It takes a few minutes, it's usually not painful, and it rarely scars when done properly.
Other clinic options include gentle cautery and laser. These are usually reserved for lots of milia or milia that keep coming back.
Don't remove them yourself
Trying to dig out milia at home with a needle, pin or comedone extractor is how people end up with scars, infections and red marks that last longer than the milia would have. That's especially true around the eyes, where the skin is thin. It's tempting because they look so close to the surface. Leave it to someone trained.
Squeezing doesn't work at all, as there's no opening. Why you shouldn't pop your pimples covers the damage squeezing does even to real spots.
Pimple patches don't help either. There's no fluid for the hydrocolloid to absorb, as explained in how pimple patches work.
Preventing milia
- Wear SPF every day. Sun damage is a known contributor, and it's the highest-value step in any routine anyway: why SPF matters.
- Exfoliate gently and regularly with a retinoid or AHA, rather than scrubbing.
- Try a lighter eye cream or moisturiser if milia keep appearing where you use a rich one.
- Don't use strong steroid creams on your face unless a doctor has prescribed them, and only for as long as advised.
When to see a doctor
Most milia are harmless. Get them checked if:
- You suddenly get lots of them, or they appear in a cluster or plaque.
- They appear after a blistering rash or a burn.
- You're not sure it's milia. Several other small bumps around the eyes, including some that need treatment, can look similar.
- They're on an eyelid edge or anywhere you can't safely have them treated at a salon.
References
Berk DR, Bayliss SJ. Milia: a review and classification. J Am Acad Dermatol. 2008;59(6):1050-1063. (https://pubmed.ncbi.nlm.nih.gov/18819726/)
FAQs
Can you pop milia?
No. Milia have no opening and contain hard keratin, not pus. Squeezing just damages the skin around them. A trained professional can remove them with a sterile blade or needle.
How long do milia last?
In babies, usually a few weeks. In adults, they can clear in a few months or last much longer. Professional removal is the fastest option.
Does retinol get rid of milia?
It can help over time by speeding up skin cell turnover, and it may help prevent new ones. It works slowly and may not clear established milia on its own.
Do eye creams cause milia?
Rich creams are often blamed, but the evidence is mainly anecdotal. If you keep getting milia where you use a thick cream, try a lighter one.
Are milia the same as whiteheads?
No. Whiteheads are blocked pores with oil and sometimes pus. Milia are tiny keratin cysts with no opening.