Milia are white bumps, not acne, and should be treated differently

Dr. G. Panisri Rao, is a primary care physician at Carroll Health Group.
Dr. G. Panisri Rao, is a primary care physician at Carroll Health Group. (Carroll Hospital Center)

Those little white bumps on your face, or your newborn's face or body, may not be acne. And they may require a different tactic to treat, says Dr. G. Panisri Rao, a primary care physician at Carroll Health Group. If you're unsure, your doctor will be able to tell the difference.

What are milia and who is most likely to get them?


Milia or milium (singular) are small, white bumps/cysts that typically appear on the eyelids, nose, cheeks and upper torsos of newborn infants. When found in groups or clusters, they are called milia. They occur when keratin, [a key protein that protects the skin from damage or stress], is trapped beneath the skin's surface. We see keratin in hair, skin and nails.

Milia can occur in all age groups, but are most common in newborns and commonly confused with neonatal acne. There are different types of milia: neonatal, juvenile, primary milia in children and adults, milia en plaque, multiple eruptive milia, traumatic milia and drug-induced milia.


What's the difference between milia, pimples and other skin conditions and how can you tell the difference?

The cause of milia is unknown. Neonatal acne (which is not pimples) is triggered by maternal hormones. Milia do not cause inflammation or swelling, unlike acne, which does. Infants are typically born with milia and they clear within the first few weeks of life. Acne does not appear for at least a few weeks after birth.

In older children and adults, milia are typically associated with skin damage, including blistering, burns, skin resurfacing procedures, long-term use of steroidal creams/ointments and long-term sun damage.

The difference between milia and other skin conditions is determined by a physician's examination.

Can you and should you treat milia?

In infants, treatment is not required for milia since they typically clear within the first few weeks of life. In older children and adults, milia can clear within a few months. Some effective treatments for milia include deroofing or using a sterile needle to pick out the contents of the cyst; topical medications (retinoids); chemical peels; laser ablation; diathermy (extreme heat to destroy the cyst); destruction curettage (surgical scraping and cauterization); and cryotherapy (freezing, which is the most common method).

What if milia become irritated or infected?

Milia usually do not become irritated or infected unless they are traumatic milia. (Traumatic milia are milia that occur due to an injury to the skin such as a burn or certain health conditions affecting the skin.) They do not cause long-term issues and typically do not recur.

How do you avoid them?

Again, it depends on the causes. If it is neonatal milia, then there is no way to avoid or prevent them since they are spontaneous. On the other hand, it is possible to avoid or prevent traumatic milia since they are caused by burns, rashes or associated with drugs.

How often should parents bathe their newborns to keep their skin clean, and how can they tell if they are washing them too much or not enough?

Parents can bathe newborns up to three times per week. However if they are really clean with regular diaper changes, then three times per week is not necessary. A baby's skin will be dry and irritated if you bathe him or her too much. There also will be odor with not bathing a baby enough.


Are certain kinds of soaps better than others for infants and adults, to avoid skin problems?

Hypoallergenic is best.

What are other common skin problems that infants can develop and how they are best treated?

Cradle cap dermatitis: The causes of cradle cap dermatitis are unknown but it is speculated to be influenced by maternal hormonal changes during pregnancy, which stimulate the infant's oil glands. The overproduction of the oil leads to the scales and redness of the skin.

When the rash occurs only on the scalp, it is referred to as "cradle cap." Treatments include washing the hair with a mild shampoo and brushing the baby's hair softly to help remove the scales. If there is no improvement, parents can speak to a physician for alternative therapies.

Heat Rash: This will be arising with spring and summer coming soon. It occurs most often in babies and young children during hot and humid temperatures. It occurs when the sweat gland openings become occluded, resulting in tiny red bumps around the sweat duct openings. The tiny red bumps are moist and commonly seen in the skin folds of the neck, upper chest, arms, legs and diaper area.

Heat rashes can be managed in several ways such as by dressing the child in clothing that keeps his or her skin cool and dry; paying attention to skin folds that retain moisture; using cool water to remove body oil and sweat, and then drying the affected area; leaving the affected area exposed to the air without clothing; and using a fan or air conditioner to keep the skin cool.

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