What Is Milia And How Can You Treat It?

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If you’ve ever examined your skin up close in the bathroom mirror and spotted small white bumps, dotted under your eyes or across your cheeks, that won’t pop despite your many attempts, you may have milia. Often mistaken for whiteheads, the bumps are mostly undetectable and can cause little issue day-to-day.

But whether you have it or are unsure, or want to know the treatments that work and are available to remove them, I spoke to two skin specialists, Dr Anjali Mahto, Consultant Dermatologist at Skin55, and Pamela Marshall, Clinical Aesthetician and founder of Mortar & Milk, who share their expertise to help you in the pursuit for the healthiest skin possible.

What is milia?

Dr Mahto explains, “Milia are small white bumps or cysts that appear on the surface of the skin when dead skin cells become trapped. They are made up of keratin, a protein on the outer layer of the skin, and whilst they resemble whiteheads, they are not related to acne or infection and are simply a pocket of normal skin.”

Because milia and whiteheads differ, how they develop and therefore be effectively treated contrasts too. Marshall shares that a whitehead is a dome-shaped lesion that can turn into a larger pustule. “Milia, on the other hand, do not generally get infected and are more difficult to remove,” she says.

Milia also sticks around longer on the skin says Marshall. This is because of the build-up of keratin in a pore becomes sealed-off by epidermal cells, the outer layer of skin, and this seal is what makes the removal process more complex than simply squeezing it like you would a spot.

What causes milia?

“Milia on the face are usually formed spontaneously, and there are a number of factors that contribute,” Mahto states, who goes on to say, “Milia found around the eye area can be caused by heavy creams, where the skin around the eye is much thinner than other areas of the face. It can also occur on the nose and other areas of the body.”

Milia tends to occur as a result of skin damage – predominantly sun damage – as well as rashes and excessive use of harsh products on the skin.”

How can it be treated?

While milia can create a bumpy texture on the skin, Dr Mahto advises that it doesn’t need to be treated unless you are concerned about them, and there are products you can use at home to help minimise it. “Fewer dead cells means fewer unsightly bumps, gentle exfoliation allows the dead skin cells to be removed, resulting in much less build up,” says Mahto, recommending superficial peels containing non-abrasive AHA’s and BHA’s, including glycolic and salicylic acid as a first step. “They provide accelerated, chemical exfoliation without the need to aggressively scrub your skin and only lift off the top layer of skin.” Retinoid creams can also be used for widespread problem areas, as can chemical peels.

However, to have milia completely removed can be done in a professional setting and is not something that should be attempted at home. Marshall reveals that often people at home will use a needle to puncture the skin and then squeeze out the bumps, but as there is no guarantee that the needle is totally disinfected, so you’re at risk of infection while also squeezing out something so hard, could cause scarring.

There is also a menu of treatments to choose from in a clinic, but all should be undertaken by a qualified dermatologist or aesthetician, as they can recommend the most appropriate route to take. “The best type of treatment will also depend on the type of milia you have, as well as the number and location on the face,” Mahto says. “Before having any procedure done, especially an extraction, it is best to book a consultation with a qualified dermatologist (check their credentials on the General Medical Council Register beforehand), to see what will be best for you and your skin type.”

According to Mahto, the most common removal is via ‘de-roofing’, where a sterile needle is used to create an incision in the skin, making way for careful extraction. ‘If you have tried the usual exfoliation, chemical peels and retinol methods then electrodessication treatment is also available. This process uses electricity, and a fine metal electrode or probe to heat the skin and to destroy the milia.”

Is It Time We Took Skin Issues More Seriously?

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Even if you count yourself lucky and rarely have to worry red patches on your cheeks or an ever-growing sun spot above your left brow, we’ve all woken up with a corker of a blemish that captures the gaze of anyone you encounter for the next three days. Those who have waged a war against skin issues, including rosacea and acne will be only too aware of the mental impact these can have over time. 

This week, the British Skin Foundation shared a survey that revealed that nine in 10 dermatologists believe that not enough importance is placed on the psychological impact skin conditions can have on us. “This survey demonstrates that dermatologists recognise some patients experience psychological distress associated with their skin condition,” says Dr Andrew Thompson, Reader in Clinical Psychology and Practitioner Clinical Psychologist, University of Sheffield and Sheffield Health and Social Care NHS Foundation Trust.

“It also indicates that whilst dermatology is making great advances in treating the medical aspects of skin disease, perhaps not enough is being done to address the accompanying psychological effects,” says Dr Thompson. In a world where we can disguise skin concerns with make-up or add a filter to a selfie some might assume that battling with a skin concern is less of an issue than it used to be. However, in the last few months, two writers have shared their experiences with rosacea and psoriasis and how they have impacted their confidence and mental health.

While Rose Gallagher might appear to be confident on her Instagram stories, she revealed that her rosacea still affects her mental health: “It still impacts how attractive I feel in myself, especially when it flares up.” On the other hand, Sophie Cullen struggled to have her psoriasis diagnosed.

This is not uncommon as Consultant Psychologist Dr Alexandra Mizara explains, “Skin patients often experience that they are not listened to or understood by their healthcare providers. The occasions that they are listened to and understood are rare and extraordinary.”

So, how can you seek out support, or help someone you know? “If you suffer with a skin condition that has impacted adversely on your life, talk openly about it to your doctor and ask them to refer you to see a psychologist,” says Dr Mizara. If you don’t get far with this, it is also worth seeking out skin disease wellbeing services in your area or talk-based therapies to help tackle any low mood or anxiety. Dr Mizara also recommends looking up charities and support groups.

For those looking for a natural remedy to help ease their skin issues, Clear Skin Complex by Viridian contains probiotics, zinc, selenium and burdock root to help soothe a range of conditions, including acne, eczema and psoriasis. While it won’t fix these concerns overnight, it does help support your body and ease inflammatory skin conditions. Shabir has written extensively about the supplement, here.

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