Milia

Causes, Risk Factors, and Treatments

Figure: Close-up of milia on the eyelid of an adult. Milia are tiny cysts just under the skin’s surface, often appearing as small white or yellowish bumpsvitalskinderm.com.

What Are Milia?

Milia (singular: milium), also known as “milk spots” or “oil seeds,” are small benign cysts that form just under the skin. They look like firm, white or yellowish bumps, most commonly on the face (especially around the eyes, cheeks, and nose) but can occur anywhere on the bodyvitalskinderm.com. These tiny bumps are filled with keratin (a skin protein) trapped beneath the skin. Milia are not acne – they contain no pus and are not caused by bacteria or hormones, and they typically lack the redness or inflammation of pimplesvitalskinderm.com my.clevelandclinic.org. Importantly, milia are harmless and usually only affect one’s appearancemy.clevelandclinic.org. They usually don’t cause pain or itching; some people don’t even notice them unless irritated by friction (for example, from clothing or sheets)vitalskinderm.com.

Milia are very common, especially in infants. In fact, about 40–50% of full-term newborns have milia on their face at birthvitalskinderm.com my.clevelandclinic.org. In newborns, these “milk spots” are considered normal and tend to disappear on their own within a few weeks, requiring no treatmentmy.clevelandclinic.org. Children and adults can develop milia as well – in these cases the milia may persist longer (sometimes for months or more) if not removedvitalskinderm.com. Regardless of age, milia pose no health risk; they are a benign cosmetic issue that will not scar or permanently damage the skin on their own. However, if milia don’t resolve or if their appearance is bothersome, safe removal options are available (described below).

Causes of Milia

Milia form when dead skin cells and keratin become trapped beneath the outer layer of the skin instead of being shed normallymy.clevelandclinic.org. In healthy skin, old cells naturally flake off to make room for new cells. But if this natural exfoliation doesn’t occur properly, a small plug of keratin can get enclosed under new skin, forming a hard, tiny cyst. Each milium is basically a little keratin-filled bump sealed under the skin. Unlike typical acne cysts, milia have no opening to the surface and thus cannot be “popped” in the usual way.

Figure: Multiple milia on the face. These superficial white bumps are formed by keratin trapped under the skin’s surface when dead cells fail to shed normallymy.clevelandclinic.org.

While the fundamental cause is trapped skin debris, several factors can contribute to milia development by altering how the skin sheds or heals. These include:

Skin Damage or Trauma: Healing skin can develop milia, so any injury or irritation that disrupts the top skin layer can trigger them. Examples include burns or scalds, blistering rashes (like poison ivy), abrasions, or even skin resurfacing procedures (such as dermabrasion or laser treatments) that cause the skin to repair itselfvitalskinderm.com. Milia that arise this way are often called secondary or traumatic milia. They may appear along the edges of old blisters or wounds as they heal.
Sun Damage: Long-term sun exposure can make the outer skin thicker and more leathery, which may hinder the normal shedding of dead cellsallaboutvision.com. Skin that has been chronically sun-damaged (rough or weathered skin) is more prone to developing milia because dead cells become trapped more easilyallaboutvision.com. Protecting your skin from UV damage (e.g. using sunscreen) can help reduce this risk.
Heavy Skin Products: Using thick, oil-based creams or ointments can lead to milia in some casesmy.clevelandclinic.org. These products may clog pores or create a film that makes natural exfoliation difficult. Milia can form as a reaction to heavy moisturizers, oily makeup, or petrolatum-based ointments applied to the facemy.clevelandclinic.org. (This is another form of secondary milia – the skin responds to the product by sealing over keratin plugs.)
Long-term Topical Steroids: Chronic use of steroid creams can thin out the epidermis and alter skin structure, paradoxically making it easier for keratin to become trappedvitalskinderm.com. Milia are a known side effect of long-term steroid ointment use on the facemy.clevelandclinic.org. If you are prescribed a steroid cream, use it only as directed by your provider to minimize this risk.
Genetic and Autoimmune Conditions: Rarely, milia can be associated with certain genetic skin disorders or autoimmune diseases. Some inherited conditions (for example, a few types of genodermatoses) cause multiple milia as part of their featuresvitalskinderm.com. Autoimmune blistering diseases (like lupus or lichen planus) that damage the skin can also heal with milia in the affected areascommons.wikimedia.org commons.wikimedia.org. These cases are uncommon, and milia arising in unusual patterns may prompt a dermatologist to look for an underlying condition.
Lifestyle Factors and Skin Care Habits: Poor skin hygiene or anything that interferes with normal exfoliation can contribute. For instance, not cleansing your face regularly, sleeping in heavy makeup, or using comedogenic (pore-clogging) products may increase milia formationvitalskinderm.com. On the flip side, over-exfoliating or harsh scrubbing can irritate the skin and cause tiny abrasions that heal as milia. A balanced skin care routine that gently cleanses and exfoliates is best. Additionally, chronic lack of sleep and stress might affect skin turnover and healing, indirectly playing a role in milia for some peoplevitalskinderm.com. (These lifestyle factors are not direct causes but can exacerbate other skin issues.)

Types of Milia

Dermatologists classify milia by the context in which they appear. Understanding the type of milium can help in choosing the appropriate management:

Neonatal Milia: These are the tiny white bumps seen on newborn babies. They typically show up on the nose, chin, or cheeks at birth or shortly aftermy.clevelandclinic.org. Neonatal milia are extremely common (affecting up to half of all infants) and are completely benign. No intervention is needed – they resolve on their own within a few weeks as the baby’s skin maturesmed.stanford.edu med.stanford.edu. (It’s important to note that neonatal milia are not “baby acne” – baby acne usually appears a bit later and involves red inflammatory pimples, whereas milia in newborns have no rednessmed.stanford.edu.)
Primary Milia (Children and Adults): “Primary” milia refer to those that arise spontaneously, rather than after an injury. They commonly occur on the face – around the eyelids, under the eyes, on the cheeks or forehead – but can also appear on the genital area in some casesmy.clevelandclinic.org. Primary milia can occur at any age. In older children and adults, these milia may persist for months (or longer) if not removed, but sometimes they do disappear after a period of timevitalskinderm.com. They are generally isolated or few in number.
Secondary Milia (Traumatic Milia): This type appears after the skin has been damaged or injured. Any event that causes a break in the skin can lead to secondary milia during healing. For example, severe sunburns, blistering rashes, burn injuries, or even laser resurfacing/chemical peels can result in small milia forming as the skin repairs itselfmy.clevelandclinic.org. Secondary milia might show up along the edges of a healed burn or within an area of previous rash. They can also result from long-term steroid use or heavy creams as mentioned above (sometimes called drug-induced milia if linked to a medication)commons.wikimedia.org my.clevelandclinic.org. Treating the underlying cause (if ongoing) and then removing the milia if needed is the typical approach.
Milia en Plaque (rare): Milia en plaque is an unusual form in which multiple milia cluster on an inflamed, raised patch of skin (a plaque). It most often affects middle-aged women for unclear reasonsmy.clevelandclinic.org. Common sites include the eyelids, just behind the ears, or on the jawline. The clusters of milia sit on a red, rough area of skin that may be several centimeters wide. Milia en plaque is benign but often persistent. It sometimes has associations with autoimmune skin conditions like discoid lupus, but it can also occur idiopathically (on its own)commons.wikimedia.org commons.wikimedia.org. Dermatologists may treat it with medications (such as topical retinoids or oral antibiotics) in addition to removal of the milia.
Multiple Eruptive Milia (rare): In this scenario, crops of milia appear over time in various areas. A person might notice dozens of new milia popping up in waves over weeks or months. The milia can be slightly itchy in this conditionmy.clevelandclinic.org. Multiple eruptive milia can occur without an obvious trigger, though in some cases they have been linked to genetic syndromes. It’s a very uncommon presentation. Treatment may involve topical retinoids or repeated physical removal; sometimes a series of laser resurfacing treatments is used if the milia are widespread.

Preventive Skin Care Tips

Completely preventing milia is not always possible – and newborn milia, in particular, cannot be prevented. However, for adults, maintaining healthy skin habits can reduce the likelihood of milia. Here are some skincare tips that may help keep milia at bayvitalskinderm.com vitalskinderm.com:

Sun Protection: Protect your skin from sun damage. Daily use of a broad-spectrum, light (non-comedogenic) sunscreen on the face can prevent the sun-induced roughness that contributes to miliavitalskinderm.com. Wearing hats and seeking shade also helps.
Choose Lighter Skincare Products: If you’re prone to milia, opt for oil-free or non-comedogenic moisturizers and makeup. Thick, heavy creams can clog pores and hinder exfoliation, so use lighter lotions that still hydrate without sealing over the skinvitalskinderm.com vitalskinderm.com.
Regular Gentle Cleansing: Wash your face daily with a mild cleanser to remove dirt, oil, and makeup. Keeping the skin clean prevents buildup that can block pores. Avoid harsh soaps or over-washing, which can irritate or overly dry the skinvitalskinderm.com. Gentle is key – irritation can lead to more problems.
Exfoliate Moderately: Incorporate gentle exfoliation a few times a week to encourage the shedding of dead skin cellsvitalskinderm.com. This can be done with a mild scrub or, even better, with chemical exfoliants (like a toner or serum containing alpha-hydroxy acids or salicylic acid) that dissolve dead cells without aggressive scrubbing. Don’t over-exfoliate – 2–3 times weekly is enough for most people, as excessive exfoliation can cause micro-injuries.
Use Medications as Directed: If you use prescription creams (for example, steroid creams for eczema), follow your doctor’s instructions and use them only for the recommended durationvitalskinderm.com. Prolonged use of steroids on the face should be avoided unless absolutely necessary, as it can thin the skin and make milia more likely. If you have a chronic condition requiring topical medication, work with your healthcare provider to minimize side effects on the skin.

By following these practices, you support your skin’s natural renewal process and reduce factors that contribute to milia formationvitalskinderm.com. While not every case of milia is preventable, healthy skin habits improve overall skin texture and can make milia less frequent.

Treatment and Removal Options

In infants, no treatment is required for milia – they will go away on their own given timemy.clevelandclinic.org. Even in adults, milia are purely cosmetic and do not need to be removed for health reasonsmy.clevelandclinic.org. That said, many people prefer to remove them, especially when they occur on the face or eyelids. Never try to pick, pop, or lance a milium at home, as this can damage the skin and lead to infection or scarringmy.clevelandclinic.org. The cysts have no pore opening, so picking usually won’t succeed in extracting the contents – instead, it will just irritate the skin. If you have milia that persist and bother you, it’s best to seek treatment from a dermatologist or qualified skin specialist.

Professional milia removal is typically quick and done with minimal discomfort. The treatments focus on either exfoliating the skin to encourage the milia to come out or physically removing the cyst. Here are the common strategies for managing miliamy.clevelandclinic.org my.clevelandclinic.org:

“Watch and Wait”: Often the simplest approach is to do nothing and let the milia resolve naturally. In babies, milia almost always clear within a few weeks on their ownmy.clevelandclinic.org. In adults, some milia may also disappear over time as the skin renews, though this can take a few monthsmy.clevelandclinic.org. If the milia are not very noticeable, a provider may recommend a period of observation.
Improved Skincare and Exfoliation: If you have recurrent milia or many small ones, upgrading your skincare routine can help. Gently washing the face daily and using an exfoliating product can gradually help milia to surface. Over-the-counter products containing ingredients like salicylic acid, glycolic acid, or retinol aid in removing dead skin and unclogging the top layervitalskinderm.com. For example, a nightly application of a cream with a low-strength retinoid (vitamin A derivative) can thin the stratum corneum and help release trapped keratin. Note: Avoid using exfoliating acids or retinoids on the delicate eyelid area without medical supervision – milia on the eyelids should be treated professionallyvitalskinderm.com. Always start slowly with new exfoliants to avoid irritation.
Topical Retinoid Medications: If drugstore options don’t help, a dermatologist might prescribe a stronger topical retinoid, such as tretinoin or adapalene, to help clear persistent miliamy.clevelandclinic.org. These vitamin A creams increase cell turnover and help unplug the cysts over several weeks. This approach works best for multiple milia or when new milia keep forming. It can make the skin more sensitive, so sunscreen is important during use. Retinoids are not used on infants, but can be an option for older children or adults with physician guidance.
Manual Extraction (Deroofing): This is a simple in-office procedure to physically remove a milium. The practitioner uses a sterile needle, lancet, or a tiny blade to puncture the very surface of the cyst, creating an openingmy.clevelandclinic.org. Then the keratin material is carefully expressed (pushed out) using a comedone extractor tool or by gentle pressurencbi.nlm.nih.gov. The procedure is quick and relatively painless – at most you feel a small pinch. No anesthetic is needed for most milia, though a numbing cream can be applied if a patient is very sensitive. After extraction, a little spot of scab will heal over a few days. Do not attempt this yourself at home, as using improper tools or technique can easily hurt the skin. Dermatologists and trained aestheticians use tiny instruments under magnification to do this safely.
Chemical Peels: Superficial chemical peels can be used to treat and prevent milia, especially when there are numerous milia or textural skin issues. Peels involve applying a mild chemical solution (such as glycolic acid or salicylic acid) to exfoliate the outer skin layerhealth.com. Over the next few days, the top layer of skin painlessly peels off, taking some milia with it and often exposing fresher, clearer skin beneath. A series of light chemical peels can make the skin less prone to trapping keratin. These are typically done by dermatologists or licensed skin professionals. After a peel, proper sun protection is needed as the new skin is temporarily more vulnerable.
Cryotherapy: For certain persistent milia, cryotherapy is an option. In cryotherapy, a very cold substance (usually liquid nitrogen) is applied to the milium to freeze and destroy ithealth.com. This is the same method often used for warts or other skin lesions. Freezing creates a tiny blister that will slough off along with the milium after a week or two. Cryotherapy may be used for tougher milia or milia in plaque-type formations. It can cause a bit of redness or a small scab, but when done properly, it heals with minimal to no scarring. A downside is that liquid nitrogen treatment can be a little uncomfortable (a brief stinging sensation) and is not precise for areas like the eyelids – it’s more commonly used for milia on other parts of the face or body.
Electrodessication (Heat Therapy): This technique uses a fine-tipped electrical cautery or high-frequency device to zap the milium. Essentially, a tiny cauterizing probe is touched to the bump to heat and destroy the keratin cyst. It’s a quick procedure that leaves a small crust which heals in a few days. Electrodessication (also called diathermy) can be very effective for stubborn milia and is often used when extracting with a needle isn’t successful. Like other methods, there is a slight risk of temporary skin marks, but scarring is rare when performed carefully. This treatment should only be done by a trained professional, given the need for precision (especially near the eyes).
Laser Ablation: Laser treatment is a modern, precise way to remove milia. In laser removal, a focused beam of light is used to target the cyst and essentially vaporize it without significantly harming the surrounding skinhealth.com. The laser creates a tiny opening in the surface and eradicates the keratin inside the milium. This method can be especially useful for clusters of milia or milia in delicate areas where using a blade or needle is difficult. Ablative lasers such as the Erbium:YAG or CO₂ laser are commonly used for this procedure, as they can precisely remove very thin layers of skin. The benefit of laser removal is a very controlled treatment with typically minimal post-procedure inflammation. After laser treatment, the treated spots form small scabs that heal over one to two weeksbellaplasticsurgery.com.aubellaplasticsurgery.com.au. Laser ablation has a low risk of scarring or pigment change when done properlyhealth.compubmed.ncbi.nlm.nih.gov. It’s a quick, “walk-in, walk-out” procedure – often done without any numbing, or with just a bit of topical anesthetic if neededbellaplasticsurgery.com.au.
- At our clinic, we utilize the advanced Fotona Dynamis SP Pro laser system for milia removal. This platform includes an Erbium:YAG laser and a Nd:YAG laser, allowing us to treat the milia very precisely. The Erbium laser in particular can gently “ablate” (evaporate) each milium with extremely fine control, removing the cyst while sparing the healthy skin around it. This precise control and minimal thermal damage make the Erbium:YAG laser an ideal tool for sensitive areas (like around the eyes) where even minimal scarring must be avoidedpubmed.ncbi.nlm.nih.gov. In a published case, for example, Erbium laser treatment successfully cleared a cluster of stubborn milia around the eyes with no scarring or pigment changes, demonstrating how effective and safe this approach can bepubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov. We can also attach a fractional laser handpiece to our Fotona system when needed – this creates an array of microscopic laser dots. Fractional laser resurfacing is useful if you have a broader area of milia or rough skin; it helps resurface the skin gradually and encourages the release of multiple milia in one session. After laser treatment, you will have some tiny crusts for about a week, and it’s important to follow post-care instructions (like keeping the area clean, moisturized, and avoiding sun) to ensure proper healingbellaplasticsurgery.com.au bellaplasticsurgery.com.au.
Light-Emitting Diode (LED) Therapy: LED phototherapy is a non-invasive light treatment that can be used as a complementary procedure after milia removal or to improve overall skin health. While LED alone doesn’t remove existing milia, certain wavelengths of light can reduce skin inflammation and boost the healing process. For instance, red and near-infrared LED light stimulate circulation and collagen production in the skin, which helps the tiny extraction or laser sites to heal fasterbellaplasticsurgery.com.au. Blue light can reduce bacteria and oil and improve skin clarity. LED therapy is painless – you simply relax under an array of lights for a specified time. We offer MediLUX LED sessions for patients as part of milia treatment: after extracting or lasering the milia, a session under the LED lamp can calm any redness and promote quicker recovery of the skin. In fact, we include LED treatment post-laser to “accelerate the healing process,” helping your skin rebuild itself with minimal downtimebellaplasticsurgery.com.au. LED therapy is very safe for all skin types and has no UV rays. It’s a relaxing add-on that ensures you get the best aesthetic result from your milia removal – aiding in skin rejuvenation and potentially reducing the chance of milia recurrence by improving the skin’s overall turnover.

Figure: Example of a light-based therapy in use. Our clinic’s medical-grade LED device (MediLUX) bathes the skin in specific wavelengths of light to speed up healing and rejuvenation. Red and near-infrared light, for instance, can increase circulation and stimulate collagen in the skin, aiding recovery after milia removalbellaplasticsurgery.com.au.

What to expect after treatment: Most milia treatments have minimal downtime. Following manual extraction or laser, you might have small red spots or scabs at the treatment sites for a few days. It’s important to keep the area clean and avoid picking at any crusts while the skin heals. We will provide aftercare instructions – for example, avoiding direct sun on the treated area and using a gentle ointment if needed to protect the skinbellaplasticsurgery.com.au bellaplasticsurgery.com.au. With proper care, the skin usually heals within one to two weeks, and any mild redness fades over timebellaplasticsurgery.com.au. Because milia do not involve an infection, healing is generally straightforward (unlike a popped pimple, milia removal rarely leaves a noticeable mark once fully healed).

Results: Once a milium is properly removed, it is gone for good. However, removing existing milia doesn’t prevent new ones from forming in the future. Some people may never get another milium, while others (especially those with ongoing risk factors or very rich skincare routines) might develop more milia over time. Maintaining good skincare habits as discussed can help minimize new milia. If new milia do appear, they can also be treated – occasionally an extra follow-up treatment is needed for a few that were resistant or newly visible after an initial procedurebellaplasticsurgery.com.au. Overall, patients are happy to see smoother skin immediately after removal – the tiny “white bumps” are gone, and once the slight post-treatment redness resolves, the skin’s texture is more even. Milia removal is considered a very safe and routine cosmetic procedure when done by professionals, and it can significantly improve the look of the skin around the eyes or on the face for those who have been bothered by these stubborn little cysts.

Conclusion

Milia are a common skin condition that can affect anyone from newborns to adults. The good news is that they are benign – they won’t harm you and often they’ll clear up on their ownmy.clevelandclinic.org my.clevelandclinic.org. If you choose to have them treated for cosmetic reasons, there are many effective options ranging from simple exfoliation to advanced laser therapy. In our practice, we take a gentle but exact approach: we can advise you on skincare to prevent milia, and we offer precise removal techniques (including the latest laser and LED technologies) to clear existing milia with minimal discomfort and downtime. With proper care, your skin will heal up good-as-new, milia-free. Remember, if you have any concerns or are unsure about bumps on your skin, it’s always best to consult a professional. We are here to answer your questions and help your skin look its healthiest.

Sources: (All information in this pamphlet is drawn from authoritative medical sources and dermatology references for accuracy.)

Gallardo Avila, P.P., & Mendez, M.D. Milia. StatPearls Publishing. (2023) – NCBI Bookshelf vitalskinderm.com ncbi.nlm.nih.gov
Cleveland Clinic – Milia (Milk Spots): Causes & Treatment. (Last reviewed Aug 2022) my.clevelandclinic.org my.clevelandclinic.org
VitalSkin Dermatology – A Guide to Milia: Causes & Treatment Options. (2025) vitalskinderm.com vitalskinderm.com
All About Vision – Hellem, A. What are milia and how to remove them. (2021) allaboutvision.com allaboutvision.com
Medical News Today – Milia under eyes: Causes and treatment. (Stanford School of Medicine, 2018) commons.wikimedia.org commons.wikimedia.org
Health.com – Wynne, K. Milia Removal: Purpose, Risks, and Results. (2023) health.comhealth.com
Bella Plastic Surgery (Sydney) – Laser Milia Removal – Clinic FAQ Page bellaplasticsurgery.com.au bellaplasticsurgery.com.au
Voth, H., & Reinhard, G. Periocular milia en plaque successfully treated by erbium:YAG laser ablation – J. Cosmet. Laser Ther. 13(1):35-37 (2011)pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
Bella Plastic Surgery – MediLUX LED Light Therapy – Clinic description page bellaplasticsurgery.com.au bellaplasticsurgery.com.au
DermNet NZ – Milia – Images and information. (2009) med.stanford.edu med.stanford.edu

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