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Milia under eye problem sample photograph

Adult milia under eye problems? These ‘milk spots’ can be treated, and prevented

Editorial note: an earlier version of this article was first published on October 12, 2011. It was updated on August 13, 2020.

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Milia is a condition in which very small, white bumps (sometimes called ‘milk spots’) form on the skin’s surface. In fact, they are cysts enclosed with keratin inside of them. Though they resemble acne, they can’t be popped – they are completely ‘plugged up.’ In babies, they are very common, and resolve on their own. In adulthood, they are frequently found under the eyes and on eyelids (though they can occur elsewhere). At this stage, they seem to appear out of nowhere. Thus we commonly get asked: how can I remove milia around my eyes?

The good news is, milia can be treated. Below we’ll explain more about this condition, and what can be done about it.

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Milia can look like other skin conditions; see a doctor about your problem first

Milia can look like acne, keratosis pilaris, syringoma, epidermal cysts, skin tags and other conditions. There are different types of milia, such as milia en plaque, primary milia and secondary milia. Milia can be caused by other disorders, such as Gardner syndrome, nevoid basal cell carcinoma syndrome, Bart syndrome, rosacea, eczema, sun damage and many others, which you can read about here.

So, before you go about trying to treat milia – even if it is just one milium – you should know what it is, or what is causing it. This goes especially if you find that your little white bumps are persistent, itchy, blistering, hurting or forming a plaque patch.

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Skin can be over-treated, leading to milia

The other important thing to know before trying to dispel your keratin bumps, is that they may have begun with too much irritation, over-exfoliation or excessive oil in your skin care routine.

These tiny white or flesh-coloured bumps on your under-eye area are made of trapped skin cells that couldn’t escape out of your pores or sweat ducts. It could be that damaged skin tried to heal over a build-up of oil. The oil clog may have stemmed from incorrect product application. Or, your skin – for one reason or another – was unable to exfoliate itself (i.e. shed skin cells properly).

If you are one who constantly ‘experiments’ with skin products, or has recently experienced trauma to the skin (even if it was intentional), this may be why you have milia under the eyes. It is not necessarily genetic, the way keratosis pilaris is.

So, don’t scratch, pick at or tweeze your milia. You may cause more damage. Or worse – infection.

The other thing you don’t want to do is attempt to apply random creams and topical solutions to the affected area. These could only exacerbate the issue. See our tips below about this.

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Treatments to remove stubborn, adult milia under the eyes or elsewhere

Whether you have milia cysts around the eyes, eyelids, or elsewhere on your face and body, they can be removed with simple measures, in a professional setting.

The most common treatments for milia are:

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Laser removal

A laser can remove the top layers of skin that are trapping dead skin cells and oil underneath. This method uses light-based heat energy to ‘zap’ the bumps, so that they fall off. This can be done with a CO2 laser, or an ablative laser, like the Erbium YAG (Er:YAG).

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Manual deroofing, lancing or excision

Using a sterile needle, extractor or small surgical cutting tools (shavers, really), the contents of the cysts can be manually removed.

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Electrocauterization (electrosurgery)

Some doctors use a medical tool that delivers a slight electrical current to the skin, through a pin-sized ‘pen’ point (or, something like it). This can essentially burn off the excess skin build up.

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Cryotherapy

This method uses liquid nitrogen to freeze off an area of skin.

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Chemical peels

While chemical peels can be the cause of milia, they can also be a helpful treatment for them. A clinical application of alpha and beta hydroxy acids (AHAs and BHAs) can exfoliate the skin, allowing the clogged pores and ducts to release the dead skin cells inside of them.

See related on our blog: Types of chemical peels: what are they and which one do you need?

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Vitamin A and retinol products

Vitamin A and its derivatives, known as retinoids, are also great exfoliators. This type of ingredient is commonly used to treat acne and wrinkles. That’s because of its ability to speed up cell turnover. When it comes to milia under the eyes, a retinol product can work similarly to chemical exfoliants.

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Which procedure is best for removing milia?

The procedure that’s right for your milia should be determined by a doctor. Some people’s skin may be too sensitive to receive certain treatments. Or, their skin type could be prone to discolouration, if the wrong treatment is chosen.

If you live in the Vancouver area, we are able to do any of the above treatments for you, at our Surrey clinic. We encourage you to book a consultation as a first step. We’ll take a closer look, and offer you our best recommendations.

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How to prevent future milia with the right skin care routines

After your milia is treated by a professional, you’ll want to avoid recurrence of these pesky little milk spots. This can be tricky for those with dry skin around the eyes, since it’s hard to keep the area supple without skin care products. The skin around the eyes doesn’t produce oil, so it can’t maintain its own moisture balance. It’s also very thin, making it easy to lose whatever moisture it has. This is due to the inevitable occurrence of transepidermal water loss (TEWL).

So, if you are prone to persistent milia in adulthood, your goal will be to hydrate, moisturize and prevent water loss without clogging your pores. You can do this with the following routines:

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Gently cleanse and exfoliate your skin daily

Morning and evening, keep your skin in tip-top shape by cleansing it well. Once or twice a week, you can exfoliate with a scrub or mask.

The cleanser you choose should be detergent and soap free, so that it does not strip your skin of the oils it needs. It’s true you want to get rid of excess oil. But your skin is partially made up of fats, so you don’t want to lose too much of it.

Some people opt to do a double cleanse, and this can be especially useful if you are prone to forming milia. A double cleanse is done in two steps. First you remove makeup with an oil-based cleanser. Then, follow with a foaming gel cleanser to remove the oil, and to get your skin really clean.

Do not, under any circumstances, leave oily makeup remover on your face! This can lead to more clogged pores.

After you cleanse, consider using leave-on exfoliants (in the form of toners, creams, serums, etc.). These include low-dose chemical ingredients such as the AHAs and BHAs mentioned above. They continue to keep your skin in ‘exfoliation mode’ throughout the day or night. Retinol can also perform this function.

Watch your skin carefully when using any exfoliator, cleanser or retinoid. Avoid excessive dryness, and build up your use of these products (especially retinol), until your skin gets used to them. If dryness persists, switch to gentler alternatives. Or, better yet, seek professional advice.

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Use non-comedogenic products

“Non-comedogenic” means that a skin care product won’t clog your pores. Whether it’s makeup or moisturizer, you want to look for this label on the skin care products you buy.

Avoid comedogenic ingredients such as skin oils (lanolin, coconut oil, palm oil), paraffin or petroleum-based products (in jellies, oils, ointments), mineral oil, shea butter, sodium laureth sulfate and so on. Or, just stick to products that say “non-comedogenic” on them; they’ve done the work for you!

Now, some products have different levels of comedogenicity. Meaning: they can clog your pores at different degrees, or not. So, you’ll want to monitor your reactions to any products you use. It may be that even if you had milia before, using a product that isn’t explicitly stated as non-comedogenic may be fine for you.

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Keep your skin hydrated and moisturized

Topical skin hydration comes in the form of humectants. Humectants can include a variety of ingredients. However, the most popular ones would be hyaluronic acid, squalane, glycerin, lactic acid, glycolic acid, panthenol plus cetyl and stearyl alcohol. These bind to water, and hold it in your skin. However, they can evaporate with water too. So, that’s where you’ll want to ‘lock’ them in with a non-comedogenic moisturizer, as noted above.

Keeping water and lipids (fats) in your skin is what gives it moisture. When it is moisturized, it functions properly – and that includes with cell regeneration. But, keep in mind that being moisturized is not the same as being oily.

Of course, drink water and eat healthy – your skin needs it to keep functioning properly!

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Avoid sun damage with good sun protection

Many skin problems can arise from exposure to UV light. Sun damage can result in milia, too. There are many high-quality, non-comedogenic and even moisturizing sunscreen products on the market today. Try the ones in our shop, here.

When possible, stay out of the sun, and wear sun protective clothing, too.

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To conclude: take the right, safe steps to solve your milia

As we’ve seen above, milia can seem like it pops up out of nowhere. However, it is usually caused by a stressor, such as oil-clogging skin care products, plus irritated or traumatized skin. While the keratin-filled bumps can look like white heads or small pimples, they are not – and you shouldn’t attempt to remove them on your own.

Your best bet to solving milia is to see a professional. A doctor, in particular, can assess whether your milia is actually milia, or if it is something else. After being properly diagnosed, an aesthetician or doctor can extract milia using a variety of safe, sterile methods.

Before and after having milia removed, follow an appropriate skin care routine that will keep your eyes hydrated, moisturized, cleansed and exfoliated on a regular basis.

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