Small dots or bumps can appear on the delicate skin under the eyes. Many individuals experience these minor skin changes and wonder what causes them. Understanding the different types of these under-eye dots and their underlying mechanisms can help clarify their significance. While generally harmless, these tiny spots are distinct skin conditions, each with specific characteristics and reasons for appearing in this prominent facial area.
Common Types of Under-Eye Dots
Three common types of dots appear under the eyes: milia, syringomas, and xanthelasma. Milia are small, white-to-yellow, dome-shaped cysts, typically measuring 1-2 millimeters in diameter. These firm bumps often appear in clusters on the eyelids, cheeks, nose, and forehead. Syringomas are small (1-3 mm), firm, rounded papules that can be skin-colored, yellowish, brown, or pink. They commonly form in symmetrical clusters on the lower eyelids and upper cheeks and may have a translucent appearance.
Xanthelasma appears as yellowish, flat or slightly raised plaques. These deposits are typically found on or near the eyelids, frequently at the inner corners. Xanthelasma can vary in texture, sometimes feeling soft, chalky, or semi-solid. Their distinct colors, shapes, and textures reflect their different compositions and origins within the skin.
Underlying Causes
Milia form when keratin, a protein found in skin, hair, and nails, becomes trapped beneath the skin’s outermost layer, creating a tiny cyst. This occurs when dead skin cells do not shed, and new skin grows over them, encasing the hardened cells. Factors contributing to milia development include skin damage from injury or sun exposure, prolonged use of steroid creams, certain genetic conditions, or autoimmune responses.
Syringomas result from an overgrowth of cells originating in the eccrine, or sweat, glands. These benign growths emerge during adolescence or later in life. Factors that can lead to sweat glands overworking include physical stress, intense exercise, high environmental temperatures, genetic predispositions, and specific medical conditions.
Xanthelasma is caused by the accumulation of cholesterol deposits beneath the skin, particularly around the eyelids. Approximately half of individuals who develop xanthelasma have elevated cholesterol levels, sometimes linked to inherited conditions like familial hypercholesterolemia. Other medical conditions such as diabetes, thyroid dysfunction, and liver conditions are also associated with xanthelasma. The constant compression of capillaries in the eyelid during blinking can also contribute to the leakage of lipids into the subcutaneous space.
Addressing Under-Eye Dots
Addressing milia involves a combination of home care and professional treatments. At home, maintaining a gentle daily cleansing routine is beneficial. Gentle exfoliation with products containing ingredients like salicylic, glycolic, or citric acid, along with topical retinoids, can help prevent and reduce milia. Avoid attempting to pick or squeeze milia, as this can lead to scarring or infection. For persistent milia, professional options include extraction, cryotherapy, or laser therapy.
Syringomas are benign and do not require treatment unless they cause cosmetic concern. Professional removal methods include laser therapy, such as CO2 or erbium lasers, and electrosurgery (diathermy). Other options include dermabrasion, surgical excision, and certain topical or oral medications like retinoids or trichloroacetic acid. Attempting to remove syringomas at home is not recommended due to complication risks.
Xanthelasma does not resolve on its own and requires professional intervention for removal. Common treatment methods include surgical excision, liquid nitrogen cryotherapy, laser surgery, radiofrequency ablation, and chemical peels, often using trichloroacetic acid. Xanthelasma can recur after treatment, particularly if underlying lipid imbalances are not properly managed.
When to Consult a Professional
Consult a healthcare professional, such as a dermatologist, if you notice any under-eye dots that are growing, changing in appearance, or causing discomfort like itching or pain. Uncertainty about the identity of these bumps also warrants evaluation. A proper diagnosis is important to ensure appropriate management and to rule out other skin conditions.
For xanthelasma specifically, seeking medical advice is important because these deposits indicate underlying health conditions. Their presence can signal elevated cholesterol levels, diabetes, or thyroid problems. A medical check-up, including blood tests, is recommended to assess for these systemic health concerns before treatment.