Milia is a skin condition that many suffer from but are unaware of. They are tiny spots found most commonly in one’s face—mainly near the eye, torso, arms and legs, and genital area.

Dr Anil Kumar Bhatta, who runs Derm Dynamics, Skin, Hair & Laser Clinic, gives the Post a primer on this skin condition. Bhatta is an expert in botox, dermal filler and face lifting, and used to work as a dermatologist at Nepal Mediciti Hospital and Let Me In Korean Skin Hospital.

How does one get milia?

If you have noticed tiny white bumps on your skin, especially around the eyes or other areas with hair follicles, those are called milium—in plural, milia. They’re harmless and only affect your appearance. They are also called milky spots or white pimples, and often confused with whiteheads and acne. That is a misconception, as milia aren't a type of acne.

Milia occur when keratin, the protein found in epithelial cells that lines our body’s external and internal surfaces, gets trapped beneath the skin’s surface. Our hair, nails, and the top layer of our skin heavily rely on keratins. The protein is also found in the cells lining our organs, glands, and other tissues. The keratin beneath the skin’s surface turns into small cysts and forms milia on top of the skin.

The condition can affect people of all ages and ethnicities, but they’re most common in newborns. The moisture on the skin can also turns into keratin. So, many individuals get milia in summer, and the condition is uncommon among people with dry skin.

Excess cell turnover—ie the skin shedding dead cells and replacing them with new ones—can also be another cause of milia. Typically, your body naturally sheds dead skin cells to make way for new ones. This is crucial for maintaining healthy skin and preventing breakouts. However, if old skin cells don’t fall off, new skin grows on top of them and traps them underneath. The dead skin turns into milia.

Lastly, excessive sun exposure can result in milia too.

Types of milia

There are several types of milia, including neonatal, primary, secondary, juvenile, milia en plaque, and multiple eruptive milia.

Neonatal milia occur in infants and cause white cysts to form on their skin—usually around the nose. Primary milia are small cysts common on the eyelids, forehead, cheeks, or genitals and can affect children and adults. Secondary milia are small cysts that occur after skin damage. Burns, rashes, blisters, sunlight exposure, heavy skin creams, or ointments can also cause them.

Juvenile milia are cysts that are a symptom of an inherited condition and can be present at birth or later in life. Milia en plaque is a rare type of milia that often affects women between the ages of 40 and 60 and causes the cysts to clump together on a raised patch of skin on the eyelid, cheek, jaw, or behind the ear.

Multiple eruptive milia is another rare type of milia that causes groups of cysts to form over weeks to months on the face, upper arms, and upper abdomen. They can be itchy.

Controlling milia

One way to effectively treat milia at home is by establishing a good skincare routine. If one follows that consistently, they will get healthy skin. It will also prevent the formation of keratin cysts.

During summer, anyone who has oily skin should clean it thoroughly, at the very least, every night to wash out excess oil and prevent milia. Also, using a good coverage sunscreen and reapplying it multiple times a day is a must.

Retinoids can be applied to the face to treat milia. Face washes containing salicylic acid, glycolic acid, and lactic acid can also be helpful. While milia typically last for two to three weeks, they can sometimes persist for months. If a baby’s milia aren’t improving after a few months or worsen, it’s best to seek advice from a healthcare provider or dermatologist for proper diagnosis.