Milia – An Unwanted Eruption

By Dr Anmol Arora ( Sr Homoeopathic Specialist )

What’s with those annoying little white heads that just never seem to come to the surface and go away? What is that thick, white stuff that comes out when you finally get so frustrated you pick and poke and finally pop the bump? Milia can be the bane of your existence, particularly when they continue to form despite your best efforts at keeping your skin “clean”. Unfortunately, cleanliness isn’t problem. The skin’s ability to naturally exfoliate is.

Milia are deep seeded white bumps that form when skin cells become trapped rather than exfoliate naturally. The trapped cells become walled off into tiny cysts that appear like white beads below the surface of the skin. Milia can occur on the skin or even on mucous membranes such as the inner surface of the cheek or the vermillion border of the lips.

As the surface is worn away, the tiny cyst may resolve on its own. Far too often, though, intervention to remove the cyst may offer more rapid resolution.

Milia – An Unwanted Eruption

Milia – An Unwanted Eruption

Basic Concept

Milia are common non-cancerous (benign) skin findings in people of all ages. Milia formed directly from sloughed-off skin (primary milia) are small, fluid-filled lesions (cysts) usually found on the faces of infants and adults, while lesions formed indirectly (secondary milia) are small cysts found within areas of skin affected by another skin condition.

Milia are formed when skin does not slough off normally but instead remains trapped in a pocket on the surface of the skin. An individual milium is formed (derived) from a hair follicle (pilosebaceous unit) or from a sweat gland (eccrine gland). In primary milia in infants, the oil gland (sebaceous gland) may not be fully developed. Secondary milia often develop after injury (trauma) or blistering of the skin, which disrupts and clogs the tubes (glandular ducts) leading to the skin surface. Secondary milia can also develop on the sun-damaged skin of middle-aged and older people.


Milia are tiny epidermoid cysts. The cysts may be derived from the pilosebaceous follicle. Primary milia arise on facial skin bearing vellus hair follicles. Secondary milia result from damage to the pilosebaceous unit.


No racial predilection is recognized.


Sexual prevalence is equal for primary and secondary milia. Eruptive milia and milia en plaque occur more frequently in women.


Milia occur in persons of all ages but are typically found in infants.

Causes of Milia

  • Heavy Skin Care Products

No doubt the most common reason milia form is from smothering your skin with heavy skin care products or hair care items. Comedogenic creams and lotions may prevent the sloughing of dead epidermal skin cells. Hidden problem products include make-up removers not labeled oil-free or non-comedogenic, hair spray, hair mousse and gel, heavy sunscreens and some moisturizers. The eyelids are very thin and more likely to experience problems with milia due to cosmetics. Re-evaluate your eye make-up and eyelid make-up remover if you are finding this to be a concern.

  • Prolonged History Of Sun Damage

The formation of milia can also be due to cumulative sun exposure. Aging skin forms a thicker epidermis that may make it far more difficult for skin cells to find their way out of the glands. And thicker skin also makes for more road blocks in the pathway to exfoliation.

  • Porphyria Cutanea Tarda

Milia can also be associated with certain skin diseases, particularly blistering disorders such as Porphyria Cutanea Tarda. Fortunately, there are other symptoms associated with these blistering diseases. Blisters, for one and increased hair on the face and backs of hands and knuckles, for another. PCT is an unusual disorder. If you have milia, don’t initially jump to the conclusion you have a blistering condition.

  • Genetics

Sometimes we just inherit certain undesirable skin tendencies

Signs and Symptom

Milia are asymptomatic. In children and adults, they usually arise around the eye. Eruptive milia, as the name suggests, have a rapid onset, often within a few weeks.


  • Skin lesions
    • Milia are superficial, uniform, pearly white to yellowish, domed lesions measuring 1-2 mm in diameter.
    • In milia en plaque, multiple milia arise on an erythematous plaque.
  • Skin distribution
    • Primary milia, in term infants, occur on the face, especially the nose. They also may be found on the mucosa (Epstein pearls) and palate (Bohn nodules).
    • Primary milia in older children and adults develop on the face, particularly around the eyes.
    • Milia have been observed to occur in a transverse, linear distribution along the nasal groove in some children.
    • Secondary milia are found anywhere on the body at the sites affected by the predisposing condition.
    • Eruptive milia occur on the head, neck, and upper body.
    • Milia en plaque manifests as distinct plaques on the head and neck. Plaques have been described in the postauricular area, unilaterally or bilaterally, the cheeks, the submandibular plaques, and on the pinna.


Medical Care

  • No topical or systemic medications are effective on primary and secondary milia.

Surgical Care

  • Milia can be safely left alone, but if the patient requests treatment, then incision with a cutting-edge needle and manual expression of the contents are effective. This can be performed without local anesthetic.
  • Milia en plaque has been treated effectively with electrodesiccation, carbon dioxide laser, dermabrasion, and cryosurgery.

Homoeopathic Treatment

Thuja is a very well proven remedy for milia. To be used under the supervision of a doctor.


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