Milia appear as tiny, white or yellowish bumps on the skin. These small, benign cysts typically do not cause pain or discomfort, but their appearance is often a cosmetic concern. A dermatologist is the most reliable professional to safely address milia, as they routinely diagnose and treat these lesions. This professional approach ensures safe and effective removal, which will be detailed alongside an understanding of how these cysts form and the risks of attempting self-removal.
Defining Milia and Its Causes
Milia are small, dome-shaped cysts that form when the protein keratin becomes trapped just beneath the skin’s surface. These cysts, usually measuring between one and four millimeters, appear as firm, white or flesh-colored bumps, most commonly on the face around the eyes, cheeks, and nose.
Milia form due to a disruption in the skin’s natural exfoliation process. Instead of shedding, dead skin cells get caught under a new layer of skin, harden, and accumulate to form the cyst. Milia are categorized into two main types based on their cause: primary and secondary.
Primary milia arise spontaneously on otherwise healthy skin and can occur in people of any age, including newborns. Secondary milia, also known as traumatic milia, develop following some form of skin damage. This damage includes burns, rashes, blistering conditions, prolonged sun exposure, or certain dermatological procedures like dermabrasion.
Techniques Dermatologists Use for Removal
Dermatologists employ several techniques to remove milia, with the choice depending on the cyst’s size, location, and number. The most common method is Mechanical Derofing, often called manual extraction. This procedure involves using a sterile, fine-tipped lancet or needle to create a tiny opening on the cyst’s surface.
Following the incision, the dermatologist uses a specialized tool, such as a comedone extractor, to gently apply pressure and push the trapped keratin plug out. This technique is highly effective and is often preferred for milia located in sensitive areas like around the eyes, as it minimizes damage to the surrounding tissue.
Another established treatment is Cryotherapy, which involves applying extremely cold temperatures, typically liquid nitrogen, to freeze the cyst. The liquid nitrogen is applied using a cotton swab or a precise spray device. Freezing causes the targeted tissue to break down and eventually slough off, revealing the smooth skin underneath, often within one to two weeks.
Diathermy or Electrocautery uses heat to destroy the cyst by applying a fine probe that delivers electrical current to cauterize the milium. Similarly, Laser Ablation utilizes a focused laser beam to vaporize the cyst’s contents without damaging the surrounding healthy skin. Both heat-based and laser methods are useful for multiple milia, as the energy breaks down the hardened keratin, allowing the body to reabsorb or expel it.
Risks of Self-Extraction
Attempting to remove milia at home is strongly advised against because the process carries significant risks and is often ineffective. Unlike acne, milia are not surface blemishes and lack an external pore opening, meaning squeezing them will not expel the contents. Instead, trying to force the hard keratin plug out can lead to severe skin trauma.
A major concern with self-extraction is the risk of infection, as non-sterile tools and hands can introduce bacteria into the compromised skin barrier. This can turn a small, benign cyst into a painful, inflamed issue. Improper technique, such as excessive pressure or clumsy use of sharp objects, can cause deep tissue damage and bruising.
The most lasting consequence of self-removal is the potential for permanent scarring. Since a tiny incision is necessary to access the keratin, attempting this without professional precision can result in an irreversible scar that is far more noticeable than the original milium. Furthermore, picking or scratching at the area can lead to post-inflammatory hyperpigmentation, causing dark patches, especially in individuals with darker skin tones. Trying to extract milia without proper medical training often results in incomplete removal, which means the cyst may simply recur.