Milia are small, white, dome-shaped cysts that form when keratin, a protein found in skin, hair, and nails, becomes trapped just beneath the skin’s surface. They typically measure 1 to 2 millimeters across and look like tiny pearls embedded in the skin. Unlike acne, milia aren’t caused by bacteria or inflammation. They’re purely mechanical: dead skin cells that should naturally slough off instead get enclosed in a tiny pocket below the outer layer of skin, where the keratin sits walled off from the body’s normal shedding process.
What Milia Look and Feel Like
Milia appear as firm, round, white or yellowish-white bumps. They don’t have the redness or swelling you’d see with a pimple, and they won’t pop if you squeeze them. The trapped keratin inside forms a hard, pearl-like bead rather than the soft pus of a whitehead. They’re painless and don’t itch.
The most common locations are around the eyes, on the cheeks, across the nose, and on the forehead. They can also appear on the chest and genitals. You might notice a single milium or a cluster of several. Because they sit so close to the surface, they’re easy to spot but surprisingly stubborn to remove on your own.
Primary vs. Secondary Milia
Dermatologists classify milia into two broad categories based on what triggers them.
Primary milia develop spontaneously, without any obvious cause. The most familiar example is the tiny white bumps that appear on many newborns’ noses, cheeks, and scalps shortly after birth. These neonatal milia arise from the tiny hair follicles in the skin and almost always resolve on their own within a few weeks to months without any treatment. Primary milia can also show up in adults, particularly around the eyes and cheeks, and tend to persist longer than the newborn version.
Secondary milia form in response to something that disrupts normal skin shedding. Common triggers include burns, skin grafting, dermabrasion, and radiation therapy. Long-term use of topical steroid creams can thin the skin enough to encourage milia formation. Certain blistering skin conditions can also leave milia behind as they heal. Unlike primary milia, secondary milia are believed to originate more often from sweat gland ducts rather than hair follicles.
Why Milia Aren’t Acne
People often mistake milia for whiteheads, but the two are fundamentally different. A whitehead is a clogged pore filled with oil and bacteria, sitting inside a hair follicle that’s open to the surface. Milia are completely sealed cysts with no opening to the skin’s surface at all. That’s why squeezing doesn’t work: there’s no pore for the contents to exit through.
This distinction also matters for treatment. Acne products designed to kill bacteria or dry out oil won’t do anything for milia, because bacteria and excess oil aren’t involved.
Bumps That Look Similar
A few other skin conditions can mimic milia. Syringomas are small, firm bumps caused by overgrowth of sweat gland cells. They tend to appear in clusters around the eyes, like milia, but they’re usually yellow or skin-colored rather than white, and they measure 1 to 3 millimeters. Syringomas don’t contain trapped keratin and won’t resolve with the same treatments.
Xanthelasma, the yellowish cholesterol deposits that form on eyelids, can also cause confusion. These are flatter and more irregularly shaped than the round, pearly bumps of milia. If you’re unsure what you’re looking at, a dermatologist can usually identify milia on sight without any testing.
Milia in Newborns
Neonatal milia are extremely common. They appear at birth or within the first few weeks, most often scattered across the nose, and occasionally on the scalp, eyelids, and cheeks. When they appear along the gum line, they’re called Bohn nodules. On the roof of the mouth, they’re known as Epstein pearls. All of these are the same thing: harmless collections of trapped keratin.
No treatment is needed. Newborn milia resolve on their own as the baby’s skin matures and begins shedding cells more efficiently. Avoid applying creams or scrubs to a newborn’s skin in an attempt to speed this along.
What Causes Milia in Adults
In adults, milia often appear without an obvious trigger, but several factors can increase your chances of developing them. Heavy, occlusive skincare products, particularly thick petroleum-based ointments applied to the face, can trap dead cells beneath the surface. The skincare trend known as “slugging,” where you coat your face in an occlusive layer overnight, can make milia worse in people who are prone to them.
Sun damage is another contributor. Years of UV exposure thickens the outer skin layer and slows natural cell turnover, making it easier for keratin to become trapped. Milia are more common in middle-aged and older adults partly for this reason. Skin injuries from procedures like chemical peels or laser resurfacing can also trigger secondary milia during the healing process.
How Milia Are Removed
Milia that bother you cosmetically can be removed by a dermatologist in a quick office visit. The most common approach is manual extraction: a small nick is made in the skin’s surface with a sterile needle or blade, then gentle pressure is applied with a tool like a comedone extractor or curette to pop the keratin bead out. The procedure takes seconds per bump and typically heals without scarring when done by a trained professional.
For people with many milia or milia in difficult locations, other options include electrocautery (using a tiny electrical current to destroy the cyst), cryotherapy (freezing), or laser treatment. Topical retinoids, which speed up skin cell turnover, have been proposed as a treatment for multiple milia, though they work slowly and are better suited for prevention than for eliminating existing bumps.
Trying to extract milia at home is risky. Because there’s no pore opening, you have to break the skin to get the keratin out. Without sterile instruments and proper technique, this can introduce bacteria, cause scarring, or leave dark spots (hyperpigmentation), especially on the delicate skin around the eyes where milia are most common.
Preventing New Milia
You can reduce your chances of developing milia by supporting your skin’s natural ability to shed dead cells. Gentle chemical exfoliants containing alpha hydroxy acids (like glycolic or lactic acid) or beta hydroxy acids (like salicylic acid) can gradually help prevent keratin buildup. Retinoid creams boost cell turnover and are one of the most effective long-term prevention strategies.
Be cautious with both of these around the eye area, where milia tend to cluster. The skin there is thinner and more sensitive, so start with lower concentrations and less frequent application. Avoiding very heavy, occlusive moisturizers on your face, particularly if you’ve had milia before, can also help. Lightweight, non-comedogenic formulas are less likely to trap dead cells beneath the surface.
Daily sunscreen use matters here too. By preventing the UV-driven thickening of your skin’s outer layer, you help maintain the normal shedding process that keeps keratin from getting trapped in the first place.
Milia en Plaque
A rare variant worth knowing about is milia en plaque, where multiple milia cluster together on top of a red, inflamed patch of skin. This form typically appears behind the ears or around the eyes, though it can show up on the forehead, jawline, or collarbone area. It predominantly affects women between their 40s and 70s. Unlike ordinary milia, milia en plaque may need more aggressive treatment because the underlying inflammation can cause new cysts to keep forming. If you notice a red plaque studded with white bumps, it’s worth having a dermatologist evaluate it rather than assuming it will resolve on its own.