Milia: tiny white bumps and how to remove them safely

Key takeaways

• Milia are small keratin-filled cysts, not pimples and not trapped "fat".
• They appear at any age, in men and women, and are very common around the eyelids.
• Heavy creams, skin injury, burns and some procedures can trigger them, but often there is no clear cause.
• Squeezing at home rarely works and can leave marks, especially under the eyes.
• In clinic, a sterile needle or blade makes a tiny opening and the cyst is lifted out. Topical retinoids can help when there are many.

What are milia, and why are they so hard?

People often tell me, "Doctor, I have whiteheads under my eyes that just won't come out." When I look, they are usually milia. They feel like a tiny grain of sand under the skin.

See, what happens is, the outer layer of skin is constantly making keratin and shedding it. Sometimes a little ball of keratin gets trapped just under the surface, inside a tiny cyst. Because it sits under a thin layer of skin and has no opening, there is nothing to "pop". DermNet describes a milium as a small keratin-filled cyst that looks like a pearly white bump. When there are several, we call them milia.

They are harmless, they do not turn into anything serious, and they are not contagious.

Who gets them, and what triggers them?

Milia are common in newborns, where they usually go away within weeks. In adults, they come in a few patterns. Here is a simple way to think about them:

In my experience, the most common adult story is simpler: a rich eye cream or a heavy night cream used around the eyes for months, combined with skin that does not shed very quickly. I cannot prove that link for any one person, but changing to a lighter product is a sensible first step.

One more Indian point. Many people use over-the-counter mixed creams that contain steroids, often bought for fairness or pimples. DermNet lists corticosteroids among the rare triggers for milia, and an Indian multicentre study found that most facial steroid use was unnecessary and caused side effects in the large majority of users. If you are using any cream without knowing what is in it, bring it to your consultation. My article on the hidden steroid problem in fairness creams explains why.

Should I try to squeeze them out at home?

Normally, no. I know it is tempting. But because there is no opening, squeezing just pushes and bruises the skin around it. Under the eyes the skin is thin, so you end up with redness, a scab, and then a dark mark that lasts longer than the milium would have. In brown skin, any injury tends to leave post-inflammatory pigmentation.

Please also avoid sewing needles, safety pins and "extraction tools" from online shops. Infection and scarring are real risks, and close to the eye, I do not want you taking chances.

What you can safely do at home: - Switch to a lighter, non-comedogenic moisturiser and eye cream. - Use sunscreen daily, because sun damage is linked to a type of milia on the cheeks and temples. - Be patient. Many primary milia clear by themselves within a few months. - If you have several, ask your doctor whether a topical retinoid is appropriate for you. This is a prescription decision, and retinoids are not used around the eyes without care. My article on retinoids explains how to start.

How are milia removed in clinic?

Basically, the cyst needs a tiny exit. DermNet describes de-roofing with a sterile needle or blade as a standard option, along with diathermy (light electrocautery) with curettage or cryotherapy. A short report in the journal Cutis described a simple method: clean the skin, make a shallow nick with a fine blade, and gently press the base with forceps so the intact cyst comes out.

What it is like in practice: 1. The area is cleaned. For a few bumps, numbing is usually not needed. For many, a numbing cream can be used. 2. A very small opening is made at the surface of each milium. 3. The white keratin ball is lifted out with gentle pressure. 4. There may be a pinpoint of blood. It settles in minutes. 5. Tiny scabs heal in a few days.

For widespread milia, chemical peels, retinoids or light laser resurfacing are sometimes used. That decision depends on how many there are and where.

Milia en plaque, eruptive milia, or milia that keep coming back in the same area after an injury need a proper assessment. Sometimes they point to another skin condition that needs treating first.

Will they come back?

A removed milium does not usually come back in the same spot. But if the tendency is there, new ones can form, especially if the trigger is still present. That is why I always ask about your eye cream, your night cream and anything you are applying for pigmentation. Changing the routine is half the treatment.

How we approach this at Dr Tvacha

Removal of small growths is part of our skin work at the Thane, Andheri, Bandra and Dahisar centres. Under the Second Layer Skin Plan, I first confirm the bumps really are milia and not something else, such as small cysts, xanthelasma (yellowish patches on the eyelids) or a skin condition that needs different care. Then I quote the removal in writing, and I give you a simple routine so new ones are less likely. If your bumps are darker and firmer, my article on DPN may describe them better.

Written by

Dr Amit KarkhanisAesthetic Physician · MBBS, Dip. Dermatology (UK) · Reg. No. 2001/02/1124

Founder of Dr Tvacha, practising in Thane since 2005. Leads the weight loss and hair programmes.