What are Milia? Causes, Symptoms, and Treatments Explained

Introduction
Milia are small, white or yellowish cysts that typically appear on the skin, most commonly around the eyes, nose, and cheeks. They are often mistaken for whiteheads but differ significantly in their formation and treatment. Understanding what milia are and what causes them can help in managing and preventing these skin lesions effectively.

What are Milia?
Milia are tiny cysts that form when keratin (a protein found in skin, hair, and nails) becomes trapped beneath the outer layer of the skin. They are firm, dome-shaped bumps that usually measure 1 to 2 millimeters in diameter. Unlike acne, milia do not form in the hair follicle, which is why they are not associated with inflammation or redness.

Types of Milia

1. Primary Milia:
   
   • Develop directly from entrapped keratin and can appear in infants or adults.
   • Common in newborns and typically resolve on their own within a few weeks.
2. Secondary Milia:
   
   • Result from skin trauma, such as burns, blisters, or injuries, that block the flow of keratin.
   • Can occur after skin treatments like laser resurfacing or chemical peels.
3. Multiple Eruptive Milia:
   
   • Appear in clusters over a period of time.
   • Often seen on the face, upper arms, and upper torso.
4. Juvenile Milia:
   
   • Associated with certain genetic conditions like nevoid basal cell carcinoma syndrome.
5. Milia en Plaque:
   
   • Rare form associated with autoimmune or genetic conditions.
   • Typically appear on the eyelids, ears, cheeks, or jaw.

What Causes Milia?
Milia can be caused by various factors, including:

1. Keratin Trapping:
   
   • The primary cause of milia is the trapping of keratin beneath the skin surface. Keratin is a structural protein that forms part of the skin's outer layer.
2. Skin Damage:
   
   • Skin trauma, such as burns, blisters, or abrasions, can lead to secondary milia.
   • Certain skin treatments, including laser resurfacing, chemical peels, and dermabrasion, can also result in milia formation.
3. Sun Damage:
   
   • Long-term sun exposure can cause skin to thicken and become more prone to milia.
4. Heavy Skin Care Products:
   
   • Using thick creams, ointments, or oil-based products can clog pores and trap keratin, leading to milia.
5. Genetic Factors:
   
   • Some individuals may be more prone to milia due to genetic predisposition.
6. Medical Conditions:
   
   • Certain genetic disorders, such as nevoid basal cell carcinoma syndrome and pachyonychia congenita, can be associated with milia.

How to Treat and Prevent Milia
While milia are generally harmless and often resolve on their own, there are several ways to treat and prevent them:

Treatment

1. Topical Retinoids:
   
   • Using topical retinoids like tretinoin or adapalene can help exfoliate the skin and promote cell turnover, reducing the formation of milia.
2. Chemical Peels:
   
   • Professional chemical peels with glycolic acid or salicylic acid can help remove the outer layer of dead skin cells, allowing trapped keratin to be released.
3. Manual Extraction:
   
   • A dermatologist can perform a sterile extraction to remove milia. This involves making a tiny incision and gently extracting the keratin cyst.
4. Laser Treatment:
   
   • Laser therapy can be used to target and remove milia.
5. Cryotherapy:
   
   • Freezing milia with liquid nitrogen can effectively remove them, though this is less commonly used.

Prevention

1. Proper Exfoliation:
   
   • Regular exfoliation with gentle exfoliants can prevent dead skin cells from trapping keratin.
2. Avoid Heavy Products:
   
   • Use non-comedogenic, lightweight skincare products to avoid clogging pores.
3. Sun Protection:
   
   • Protect your skin from sun damage by using broad-spectrum sunscreen with at least SPF 30.
4. Gentle Skin Care:
   
   • Avoid harsh treatments and excessive scrubbing that can damage the skin and lead to milia.
5. Healthy Skincare Routine:
   
   • Maintain a consistent skincare routine that includes cleansing, moisturizing, and protecting the skin.

Conclusion
Milia are small, keratin-filled cysts that commonly appear on the face, especially around the eyes and cheeks. They are caused by trapped keratin and can result from skin damage, sun exposure, heavy skincare products, and genetic factors. While milia are generally harmless, various treatments such as topical retinoids, chemical peels, and professional extraction can help remove them. Preventive measures include proper exfoliation, using non-comedogenic products, and protecting the skin from sun damage. By understanding the causes and treatments of milia, you can effectively manage and prevent these small but stubborn skin lesions.