Milia are small, white bumps caused by tiny cysts of keratin (the same protein that makes up your hair and nails) trapped just beneath the skin’s surface. Unlike acne, they aren’t inflamed, don’t contain pus, and won’t respond to typical acne spot treatments. The good news: milia can be treated at home with the right products, removed quickly by a professional, or sometimes left alone to resolve on their own.
Why Milia Form
Milia develop when dead skin cells get trapped in small pockets near the surface instead of shedding naturally. They’re derived from hair follicles and commonly appear on the cheeks, nose, eyelids, and forehead. Because the keratin is sealed beneath a layer of skin, you can’t squeeze milia out the way you might a whitehead. There’s no opening to the surface.
There are two types. Primary milia appear spontaneously, often on facial skin, with no obvious trigger. Secondary milia form after something damages the skin: burns, blisters, rashes, prolonged sun exposure, or even a reaction to a heavy cream or ointment. Knowing which type you’re dealing with helps guide prevention, since secondary milia often stop recurring once you remove the trigger.
Over-the-Counter Treatments That Work
If you have a few scattered milia, topical products that speed up skin cell turnover can thin the layer of skin trapping the cyst and help it resolve. The most effective over-the-counter options include:
- Salicylic acid: An exfoliating acid that dissolves the bonds between dead skin cells, helping them shed faster. Look for cleansers or leave-on treatments containing it.
- Glycolic acid: Another exfoliating acid that works on the skin’s surface. Glycolic acid cleansers, toners, and peels all help clear the buildup over milia.
- Adapalene (sold as Differin): A retinoid originally designed for acne that increases cell turnover across the skin. It’s available without a prescription and is one of the more effective options for stubborn milia.
Retinoid creams, which contain vitamin A, are widely recommended by dermatologists for milia. They work by accelerating the rate at which your skin renews itself, which gradually pushes trapped keratin toward the surface. If you’re using a retinoid or retinol product, apply it once per day, typically at night, since retinoids increase sun sensitivity. Results from topical treatments aren’t instant. Expect mild peeling or flaking as the outer skin layer turns over, and give any product several weeks of consistent use before judging whether it’s working.
Professional Removal Options
For milia that don’t respond to topical treatments, or for bumps in sensitive areas like the eyelids, a dermatologist can remove them in a single visit. The most common procedures include manual extraction, cryotherapy, chemical peels, and laser ablation.
Manual Extraction
This is the most straightforward approach. A dermatologist uses a sterile needle or small blade to make a tiny opening in the skin over the cyst, then presses out the keratin plug. Your skin should look and feel smoother immediately afterward. Expect slight redness, swelling, and tenderness in the treated area for several days to a couple of weeks while it heals.
Cryotherapy
Cryotherapy freezes the milia with liquid nitrogen. Scabs form within about 14 days and then fall off on their own, revealing healthy skin in four to six weeks. This method is sometimes used when there are multiple milia clustered together.
Chemical Peels
A professional-strength chemical peel containing salicylic or glycolic acid removes the outer layer of skin more aggressively than any at-home product. Mild peeling and flaking are expected for 7 to 10 days, and your skin may feel dry for several weeks afterward. Once the outer layer sheds completely, the skin underneath is smoother and the milia are gone.
Laser Ablation
Laser treatment vaporizes the cyst with focused light energy. Recovery is relatively fast, with most short-term symptoms (redness, minor swelling) resolving within 5 to 9 days. This option is typically reserved for milia that are numerous, recurring, or in cosmetically sensitive locations.
Why You Shouldn’t Squeeze Them
It’s tempting to try popping milia at home, but they’re structurally different from pimples. A pimple has an opening (a pore) that allows contents to exit. Milia are completely sealed beneath the skin. Squeezing forces pressure into surrounding tissue rather than releasing anything, which can cause inflammation, broken capillaries, and scarring. Using an unsterilized needle at home also introduces the risk of infection. Professional extraction is quick, inexpensive, and avoids all of these problems.
Milia in Newborns
Milia are extremely common in newborns, appearing as tiny white or yellow bumps on the nose, cheeks, and chin. Neonatal milia are harmless and almost always resolve on their own within a few weeks to a couple of months without any treatment. There’s no need to apply products or attempt removal. The bumps disappear as the baby’s skin matures and begins shedding cells normally.
Preventing New Milia
Once you’ve cleared existing milia, a few habits reduce the chance of new ones forming. Use lightweight, non-comedogenic moisturizers and sunscreens, since heavy creams and ointments are a known trigger for secondary milia. Wearing sunscreen daily also matters because UV damage thickens the outer layer of skin and makes it harder for dead cells to shed properly.
Incorporating a gentle exfoliant into your routine, whether that’s a salicylic acid cleanser, a glycolic acid toner, or a low-strength retinol serum, keeps cell turnover steady and prevents the buildup that leads to trapped keratin. If you’ve noticed milia forming after using a specific product (a rich eye cream or occlusive balm, for instance), switching to a lighter formula is often enough to stop them from coming back.