Milia are small, white bumps on the skin caused by tiny cysts filled with keratin, the same protein that makes up your hair and outer skin layer. They’re completely benign and extremely common, appearing in people of all ages from newborns to adults. Unlike pimples, milia feel firm to the touch and won’t pop when squeezed, because the keratin is trapped beneath a layer of skin rather than sitting in an open pore.
What Milia Look Like
A single milium is a dome-shaped bump, usually 1 to 2 millimeters across, roughly the size of a pinhead. They’re white or yellowish-white, and they often show up in clusters rather than alone. The most common spots are around the eyes, on the cheeks, across the nose, and on the forehead. They can also appear on the chest, arms, or genitals, though facial milia are by far the most noticed.
Because they sit just beneath the skin’s surface, milia don’t cause pain, itching, or inflammation. They simply look like tiny pearls embedded in the skin. This is what sets them apart from whiteheads: a whitehead contains oil and dead skin cells inside a pore, while a milium is a hard keratin plug sealed under a thin cap of skin with no pore opening at all.
Primary vs. Secondary Milia
Primary milia develop spontaneously, without any obvious trigger. They form around the tiny hair follicles (called vellus follicles) on the face and are the type most people notice when they look in the mirror. There’s no underlying skin damage involved. They simply appear when keratin gets trapped during normal skin cell turnover.
Secondary milia, sometimes called traumatic milia, form after something damages the skin. Burns, blistering rashes, prolonged sun exposure, and even aggressive skin procedures like dermabrasion or laser resurfacing can all trigger them. When the skin heals from that kind of injury, keratin can get trapped in the new tissue and form cysts. Secondary milia can show up anywhere the damage occurred, not just on the face.
Milia in Newborns
Roughly 40 to 50 percent of newborns develop milia, making it one of the most common skin findings in babies. The bumps typically cluster on the nose, cheeks, and chin. In newborns, milia resolve on their own within a few weeks of birth as the baby’s skin matures and begins turning over cells more efficiently. No treatment is needed, and the bumps don’t leave scars. If your baby has tiny white dots on their face shortly after birth, this is almost certainly what you’re looking at.
What Causes Milia in Adults
In adults, the story is a bit more varied. Primary milia can appear at any age, and some people are simply more prone to them than others. But several factors raise the likelihood:
- Heavy skincare products. Thick, occlusive creams, especially rich eye creams, can trap keratin beneath the skin’s surface. People with dry skin who layer on heavy moisturizers are particularly prone.
- Sun damage. Chronic UV exposure thickens the outer layer of skin over time, making it harder for dead cells and keratin to shed normally.
- Skin trauma. Burns, blisters, rashes, or cosmetic procedures that disrupt the skin barrier can lead to secondary milia during healing.
- Slow cell turnover. As you age, your skin renews itself more slowly. Keratin that would normally shed can accumulate and get trapped.
Milia vs. Similar-Looking Bumps
Several other skin conditions can look like milia at first glance. Syringomas are small sweat gland growths that form clusters similar to milia, but they tend to be yellow or skin-colored rather than white, and they’re slightly larger, typically 1 to 3 millimeters. Syringomas are firm papules that don’t contain keratin, and they won’t resolve on their own the way milia sometimes do.
Whiteheads (closed comedones) are the other common lookalike. The key difference is texture: whiteheads are softer because they contain sebum and dead skin inside a clogged pore, while milia feel like a hard bead under the skin. Whiteheads also respond to acne treatments, and milia do not.
How Milia Are Removed
Milia in adults don’t always go away on their own. When they persist for months, professional extraction is the most effective option. 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. This procedure, called deroofing, sounds worse than it feels. At most, you’ll notice a small prick, and the results are immediate. The bump is gone as soon as the keratin is released.
Estheticians at spas and salons can also perform milia extraction in some cases, though not all states allow estheticians to pierce the skin. If you go this route, confirm that the provider is licensed and experienced with the procedure.
One important thing to know: squeezing milia at home doesn’t work and can cause scarring or infection. Because there’s no pore opening, the keratin has nowhere to go when you press on it. You’ll just damage the surrounding skin.
Preventing New Milia
You can reduce the chance of new milia forming by adjusting your skincare routine. Switching from heavy creams to lightweight, gel-based, non-comedogenic moisturizers helps prevent the pore-clogging conditions that trap keratin. This is especially important around the eyes, where the skin is thinnest and most susceptible.
Chemical exfoliants encourage faster cell turnover, which keeps keratin from accumulating under the surface. Products containing alpha hydroxy acids (like glycolic acid) or beta hydroxy acids (like salicylic acid) used once or twice a week can make a noticeable difference. Retinol, a vitamin A derivative available over the counter, works through a similar mechanism by boosting the rate at which your skin sheds old cells and generates new ones. If you’re new to retinol, start with a low concentration a few nights per week to avoid irritation.
Sun protection also plays a role. UV damage thickens the skin over time, so consistent sunscreen use helps maintain the normal shedding process that prevents keratin from getting trapped in the first place.