Milialar, pronounced “mil-ee-uh-lar”, refers to small white or yellowish bumps that commonly appear on the skin’s surface. These tiny cysts or pimples are a widespread skin condition that can affect people of all ages. In this comprehensive guide, we’ll examine the causes, symptoms, diagnosis and available treatments for milialar. We’ll also provide tips on how to prevent the occurrence of these benign cysts through proper skincare and lifestyle measures.
What Are Milialar and How Do They Form?
Milialar, or singular milia, occur when keratin becomes trapped beneath the surface of the skin. Keratin is a strong protein that makes up the top layer of skin, hair, and nails. The entrapment of keratin forms a small lump or cyst under the epidermis.
On a microscopic level, milialar consist of tiny epidermoid cysts that range from 1 to 4 millimeters in diameter. They form when the keratin-filled cells are trapped below a layer of dead skin cells. This causes a dome-shaped protrusion on the skin’s surface.
Primary and Secondary Milia
There are two main types of milia:
Primary milia occur spontaneously, without any apparent cause. They are common in newborns and often resolve on their own within a few weeks. Nearly 50% of infants develop milia around the nose, cheeks, or foreheard.
Secondary milia develop later in life due to some damage, irritation, or blockage in the skin. They may occur after:
- Sunburn or other skin injury
- Blistering disorders like herpes or dermatitis
- Topical steroid use on the face
- Heavy skin creams that block pores
- Long-term makeup use or glue from false eyelashes
Secondary milia tend to affect adults and commonly appear around the eyelids, cheeks, upper lip, and genital region. Certain medical conditions like discoid lupus can also cause widespread milia.
Recognizing the Signs and Symptoms
How can you tell if those tiny white bumps on your face are milialar? Here are the key characteristics:
- They appear as small, painless, dome-shaped, or pearl-like spots.
- The overlying skin looks normal, not red or inflamed.
- Milialar ranges from pinhead size to about 1-2 millimeters in diameter.
- The cysts can be white, yellowish, or even reddish.
- Milialar can occur as solitary bumps or in groups of multiple cysts.
- The most common locations are around the eyes, cheeks, nose, forehead, and genital skin.
- In infants, they tend to resolve spontaneously in a few weeks. But in adults, they may persist for weeks to months.
- Milialar are not open comedones like whiteheads. The keratin is trapped underneath the skin’s surface.
- They are often painless and do not itch or irritate the skin.
It’s important not to confuse milialar with other common skin blemishes:
- Acne lesions – More inflamed and may feature blackheads or pus
- Angiofibromas – Reddish papules with a classic butterfly distribution
- Epidermoid cysts – Larger, deeper lumps under the skin
- Molluscum contagiosum – Caused by a viral infection
Consult a dermatologist if the bumps are widespread or don’t disappear after a few weeks. Rarely, milia could indicate an underlying health condition.
Diagnosing Milialar
Milia are usually diagnosed simply by visual examination of the skin. The appearance of small, firm, pearly-white bumps makes milia quite distinct.
Sometimes, a dermatologist may use a dermatoscopy technique to magnify and examine the skin lesions. Under magnification, milia will have a smooth, dome-shaped pattern.
Skin biopsy is seldom required but may help confirm the diagnosis, especially when the bumps are atypical or widespread. A tiny sample of skin is extracted and analyzed under a microscope. A biopsy can help rule out other conditions like basal cell carcinoma.
Because milia are superficial cysts, doctors typically do not recommend specific blood or laboratory tests. However, they may perform tests to diagnose any underlying conditions that could be causing secondary milia.
Safe and Effective Treatment Options
Many milialar resolves spontaneously within a few weeks, so observation is often the best initial approach. However, if they persist and become aesthetically bothersome, there are several treatment options:
Extraction
If the cysts are close to the skin surface, a dermatologist can extract them. After numbing the area with an anesthetic, a small incision is made with a needle or scalpel. Using comedone extractors, the contents are gently squeezed out. Extraction helps speed up healing.
Cauterization
Electrodessication therapy uses a sterile needle to deliver an electric current. This cauterizes the cyst and stimulates healing. Multiple sessions may be required.
Laser Ablation
Using focused beams of light, lasers can precisely target and destroy the milialar cysts. This is a quick office-based procedure with minimal risk. It can treat cysts around the delicate eye area.
Cryotherapy
Liquid nitrogen is used to freeze and destroy the milialar. The cysts eventually shed off naturally. This method can temporarily lighten skin in treated areas.
Microdermabrasion
This procedure uses fine crystals to gently “sand” away the top layer of skin. It exposes trapped cysts so they can rise to the surface. Multiple treatments may be needed for desired results.
Chemical Peels
Applying a diluted acidic solution causes a controlled burn that damages the cyst wall. As the skin regenerates, the milia will release. Repeated peels improve outcomes.
Oral Medications
For stubborn, recurrent cases, oral retinoids like isotretinoin may be prescribed. These vitamin A derivatives help normalize keratinization and prevent new cysts.
Of course, every case is unique. The dermatologist will recommend the best treatment approach based on factors like number of cysts, depth, and location. Combining methods often work better for clearing milialar.
Helpful At-Home Remedies and Self-Care
While waiting for milialar to resolve or between medical treatments, some self-care steps can help:
- Gentle exfoliation with a soft scrub or washcloth increases cell turnover and may free trapped keratin. But avoid irritating the skin.
- Warm compresses can help soften the cysts and bring them to the surface faster. A clean washcloth soaked in warm water works well. Apply for 10-15 minutes twice daily.
- Avoid excessive sun exposure as UV rays can worsen milialar. Wear broad-spectrum sunscreen daily.
- Minimize the use of heavy creams around eyes and other prone areas. Non-comedogenic and oil-free products are best for milia-prone skin.
- Do not squeeze or poke the bumps as this can lead to scarring and infection. Leave extractions to your dermatologist.
- Use a gentle cleanser and moisturizer for your skin type. Keeping skin balanced helps control cyst formation.
Consult your dermatologist before trying any new topical products on cyst-prone areas. Home remedies provide basic supportive care between medical treatments.
Preventing Milialar From Occurring
While milialar themselves are harmless, taking some preventive steps can help reduce recurrence:
- Avoid trauma and damage to the facial skin from prolonged sun exposure, harsh scrubs, or irritants. This minimizes secondary milia.
- Choose oil-free, non-comedogenic makeup and skin care products. Avoid Pomades, thick creams, and petroleum jellies around the eyes.
- Protect skin from sun damage by wearing a broad-spectrum sunscreen, hats, and sunglasses outdoors. UV radiation exacerbates milia.
- Stop picking, poking, or squeezing acne, pimples, or small bumps on your face. This can lead to milia later on.
- For infants, keep skin clean and dry while avoiding over-scrubbing. Gently pat dry instead of rubbing wet skin.
- Treat any underlying skin conditions, like eczema or blistering disorders, which can cause recurrent milia.
- Adopt healthy lifestyle habits – quit smoking, manage stress levels, eat a balanced diet. This promotes overall skin health.
- Schedule regular skin check-ups for early diagnosis and treatment if needed. Be vigilant about new or worsening skin lesions.
Following sound skincare and prevention principles tailored to your skin type and needs offers the best protection against recurrent milialar cysts.
Conclusion
While milialar are usually benign and resolve on their own, these bothersome cysts can be successfully managed under medical supervision. A few key points to remember:
- Milialar arises when keratin gets trapped under the skin, forming small, hard cysts. They are most common around the eyes, nose, and cheeks.
- Do not attempt to pop or squeeze them, as this could induce inflammation and scarring.
- Various treatment options exist, like extraction, cauterization, lasers, cryotherapy, and chemical peels. Combination approaches work best.
- Prevent future cysts through gentle skin care, sun protection, and avoiding trauma or irritation to the skin.
- Seek medical advice if milialar are widespread, persistent, or worrying. Early treatment improves outcomes.
With a sound understanding of their causes and treatments, dealing with milialar can be straightforward. Work with your dermatologist to determine the best management plan for your individual case. In most instances, the bumps can be removed or controlled, restoring smooth, healthy skin.
References
- Lee, S. W., & Jung, S. Y. (2011). A study of milia occurring as a complication of allergic contact dermatitis caused by methylisothiazolinone. Contact dermatitis, 65(5), 300-304.
- Diven, D. G., Hirshkowitz, M., & Pochi, P. E. (1990). Anatomy and physiology of sebaceous glands. Journal of the American Academy of Dermatology, 22(1), 23-30.
- Sarifakioglu, E., Gurer, M. A., & Seckin, D. (2004). Traumatic milia en plaque. Pediatric dermatology, 21(2), 197-199.
- Yaar, M., & Gilchrest, B. A. (2007). Aging of skin. In Fitzgerald’s Dermatology in General Medicine. McGraw Hill.
