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It’s easy to mistake them for whiteheads: Small, pale bumps that crop up overnight, clustered under the eyes, on the cheeks, or along the nose. But before you pick up your tweezers or get to squeezing them (bad!), listen up—what looks like a mild breakout or whiteheads could actually be milia, a completely different kind of skin concern that won’t respond to your tried-and-true acne spot treatment, and definitely not to squeezing.
“Milia are tiny cysts that sit just under the skin’s surface,” explains cosmetic physician and head of education at Acquisition Aesthetics, Dr. Emmaline Ashley. “They are full of a protein called keratin, which is commonly found in your hair, nails, and the outer layer of skin.” Milia presents itself as pearly-white bumps; however, they are not inflammatory, infectious, or even remotely related to acne.
Whiteheads, on the other hand, are a type of acne lesion caused by clogged pores that are filled with sebum, dead skin, and bacteria. “Milia, however, are firmer, deeper-set, and won’t extract easily like a whitehead,” warns Dr. Ashley.
What causes milia?
Our skin isn’t just a protective barrier. It’s a living, breathing organ that renews itself once a month. As part of this natural cycle, dead skin cells are meant to shed from the surface, making way for the fresh, healthy ones beneath. But sometimes, that process doesn’t go quite as planned, causing milia.
These tiny, pearly bumps form when dead skin cells and keratin become trapped beneath the surface, rather than exfoliating as they should. They most often appear around the eyes and cheeks, delicate areas where the skin is thinner, making them more susceptible to buildup.
“Clinically, milia are smooth, dome-shaped, and feel firm to the touch,” says Dr. Ashley. “Unlike a whitehead, they don’t come to a ‘head,’ they’re not red or inflamed, and they’re usually not tender or painful unless irritated.”
According to Dr. Hussein Yassine, board-certified dermatologist and founder of Skin Expert Clinic, milia is often found in newborns and in adults with dry or damaged skin and can be triggered by multiple factors, one of them being the use of occlusive ingredients or very thick, hydrating formulas—they contribute by disrupting natural exfoliation.
“A lot of people consider petroleum jelly, like Vaseline, to be a moisturizer, which it is not,” he explains. “Not to forget the use of mineral oils, lanolin, beeswax, paraffin, and other rich natural oils, as well as cocoa and shea butter.” Even ingredients like dimethicone, commonly found in makeup, can contribute to congestion when layered too heavily. Overusing rich eye creams, failing to properly remove makeup, or relying on occlusive products in hot, humid climates can also create the perfect conditions for milia to form.
There’s also a lesser-known subtype known as traumatic milia that can occur after the skin experiences stress. Think resurfacing lasers or dermabrasion. In these cases, the skin’s natural healing process gets disrupted, trapping keratin beneath the surface as it tries to repair itself.
How to treat milia
In most cases, milia is harmless and tends to resolve on its own with time. But if it’s persistent—or simply bothersome from a cosmetic standpoint—experts recommend a combination of consistent at-home care and professional in-clinic treatments. “A skilled clinician can use a sterile needle to gently de-roof the lesion,” says Dr Ashley. “Cryotherapy, diathermy, or even laser ablation can be suggested for more extensive cases.”
Dr Yassine also recommends retinol or an in-office peel to help regenerate the skin and boost exfoliation. “You can also opt for a series of HydraFacials—they’re one of the most effective treatments for deeply cleansing the pores,” he adds.
When it comes to at-home care, consistency is key. Gentle exfoliating ingredients can gradually help reduce milia and prevent new ones from forming. Look for formulas that include retinoids to boost cell turnover and minimize keratin buildup, as well as AHAs and BHAs—especially if you’re also managing acne or congestion. But tread carefully. “Because milia tends to occur around delicate areas like the eyes, it’s important to be careful,” warns Dr Ashley. “Avoid over-exfoliating and do not attempt to extract them yourself at home.”
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While you can’t completely prevent milia from returning, experts agree that maintaining a healthy skin barrier and committing to a consistent, but gentle, exfoliation routine can significantly reduce your risk. Choose non-comedogenic, lightweight products around the eyes, avoid heavy occlusives that trap dead skin and keratin, and consider incorporating a mild chemical exfoliant once or twice a week. “Always use SPF daily, as chronic sun damage is a common contributor to primary milia in adults,” she adds.
