Milia: What They Are, What Causes Them, and How to Get Rid of Them

Milia are among the most misidentified skin concerns — commonly mistaken for whiteheads, small pimples, or blocked pores. They are none of these things. A milium is a small, firm, white or pearlescent keratin-filled cyst sitting just beneath the skin surface, with no pore opening and no inflammatory component. They do not respond to extractions, pore strips, or acne treatments. Understanding what they actually are determines whether the skincare approach you take will work at all.

What Are Milia, Exactly?

A milium (plural: milia) is a small epidermal inclusion cyst — a pocket of keratin trapped beneath the skin surface. Unlike a comedone, which forms in a hair follicle and has a pore opening, a milium has no pore opening through which its contents can be expelled. This is the critical distinction: the reason milia do not respond to squeezing or pore strips is that there is no passage to the skin surface through which the keratin can escape. Manual attempts to extract milia break the skin without removing the cyst and frequently cause scarring or secondary infection.

Milia appear as small (1–2mm), round, white or cream-coloured raised bumps, most commonly around the eyes, cheeks, nose, and forehead. They are firm to the touch and do not change with gentle pressure. They are not painful, not inflamed, and not infectious.

What Causes Milia?

Primary milia occur spontaneously — particularly around the eyes and on the cheeks — and are caused by a localised failure of the normal desquamation process. Dead skin cells that should shed naturally instead become trapped beneath the skin surface and accumulate into a cyst. Primary milia are common in newborns (where they clear spontaneously within weeks) and in adults of all ages.

Secondary milia develop in response to specific triggers:

• Heavy occlusive skincare products: Rich creams, facial oils, and heavy emollients — particularly around the delicate eye area — can impede normal desquamation and contribute to milia formation. This is one of the most common causes in adults with elaborate PM routines.
• Sun damage: Chronic UV exposure damages the mechanisms that regulate normal skin cell shedding, creating conditions where keratin accumulates beneath the surface. Sun-induced milia tend to appear on sun-exposed areas — cheeks, nose, and around the eyes.
• Skin trauma: Burns, blistering rashes (including contact dermatitis), and dermabrasion can disrupt the desquamation pathway, leading to post-traumatic milia during healing.
• Occlusive dressings or products: Any prolonged occlusion of the skin surface — bandages, certain wound dressings, even heavy slugging protocols in susceptible individuals — can create conditions for milia in predisposed skin.

Skincare Ingredients That Help with Milia

Retinoids (retinol, retinaldehyde, tretinoin): The most effective skincare intervention for both treating existing milia and preventing new ones. Retinoids normalise cell turnover and improve desquamation — directly addressing the mechanism that allows keratin to accumulate beneath the surface. Consistent retinoid use gradually thins the layer of skin trapping existing milia and prevents new cysts from forming. This is slow — resolution of individual milia can take months — but it is the most evidence-supported topical approach.

Alpha hydroxy acids (AHAs — particularly lactic acid and glycolic acid): Chemical exfoliants loosen the corneodesmosomes holding dead skin cells together, promoting the desquamation that milia formation disrupts. Regular AHA use — two to three nights per week — improves surface cell shedding and gradually reduces the keratin accumulation that sustains milia. AHAs are particularly useful around the eye area where retinoids may be too irritating.

Salicylic acid (BHA): Less relevant than AHAs for milia specifically, since milia are not follicular — but BHA use can improve overall skin turnover and prevent secondary milia in oily skin prone to both congestion and milia.

What Does Not Work for Milia

• Squeezing or attempting to extract: Milia have no pore opening. Squeezing breaks the skin surface without releasing the cyst, and typically causes bruising, swelling, and scarring around the milium — which may still be present beneath the damaged skin.
• Pore strips: Designed for open comedones in follicles. Ineffective for cysts with no surface opening.
• Clay masks: Useful for drawing out excess sebum from follicles — again, irrelevant for a sealed keratin cyst.
• Acne treatments (benzoyl peroxide, niacinamide): Target inflammatory or bacterial pathways that are not involved in milia formation.
• Adding more heavy moisturiser: If heavy occlusive products contributed to milia formation, increasing them will worsen the problem.

When to See a Dermatologist

Individual milia that are bothersome can be removed quickly and safely by a dermatologist through lancing — making a tiny incision with a sterile needle and removing the keratin plug. This takes seconds per milium and leaves no lasting mark when performed correctly. It is not a complex procedure, but it requires a sterile environment and correct technique to avoid scarring. A dermatologist can also help distinguish milia from other white bumps that may require different treatment — sebaceous hyperplasia, syringoma, or closed comedones all look similar and have different management approaches.

Preventing Milia: Skincare Adjustments

For people who develop milia frequently — particularly around the eye area — the following routine changes reduce recurrence:

• Switch from a heavy cream eye product to a lighter gel or serum formulation around the orbital area.
• Avoid applying facial oils directly over the eye area and cheekbones if milia are a recurring concern in those locations.
• Use retinol or a gentle AHA as part of the regular PM routine to maintain normal desquamation rates.
• Wear daily SPF — sun damage is an underappreciated contributor to milia formation, particularly in fair skin types.
• If slugging or using very heavy occlusives, avoid the areas prone to milia formation.