Have you ever noticed strange white dots on your face? They're called milia (singular: millium), and they're more prevalent than you think. These small, benign keratin-filled cysts are very common on babies (half of all newborns are born with them), and they afflict the faces of many adults. "Think of them as pimples with nowhere to go," says New York City-based dermatologist Joshua Zeichner, M.D. Unlike regular pimples and blemishes, the keratin in these tiny cysts is trapped without an opening, so you can't pop them!
Milia isn’t genetic, but dermatologists know of two types that can develop on the cheeks and around the eyes. Primary milia forms when keratin gets trapped under the skin without injury, “where there are high concentrations of sweat glands," says Dr. Zeichner. Secondary milia is a result of an injury that blocks skin ducts. "Skin on the cheeks and around the eyes is easily damaged by sunburn or friction, which can lead to trauma, and eventually, milia.”
If you suffer from these pesky (yet harmless) white dots, how do you get rid of them for good? Laser resurfacing treatments such as Fraxel can help reduce milia, but there are many less expensive alternatives to consider before you splurge.
"First, don’t try popping milia at home!" advises Dr. Zeichner. "Picking can lead to inflammation and permanent scarring." If you choose to visit the dermatologist, they can manually drain the cyst with a needle and a comedone extractor. For a more drastic approach, a trained professional may use an electrocautery—an electric needle tip that carefully burns the spot without scarring.
If you're looking for a simple at-home regimen, incorporate physical and chemical exfoliators into your routine to slough off accumulated dead skin. “Depending on your preference, you can physically exfoliate with a skin cleansing brush or microdermabrasion kit, or try a chemical glycolic acid wash,” says Dr. Zeichner. However, Dr. Zeichner mentions the best overall treatment for milia is preventative care. "Sunscreen can prevent burns that may predispose your skin to secondary milia," says Dr. Zeichner. "And in addition to the anti-aging benefits, a strict topical retinoid regimen can increase cell turnover, preventing new milia from forming."
Joshua Zeichner, MD FAAD, is an Assistant Professor at Mount Sinai Medical Center in Manhattan and board-certified in Dermatology.
As the Director of Cosmetic and Clinical Research in the Dermatology Department, Dr. Zeichner is actively involved in clinical trials for all skin conditions including acne, psoriasis, eczema/atopic dermatitis, and actinic keratoses/skin cancer. For more skin care tips, follow Dr. Zeichner on Twitter @JoshZeichnerMD.