What are the small white bumps on my face and how can I treat them?

Milia: Identification and Treatment

The small white bumps on your face are most likely milia, which are benign, superficial keratinaceous cysts that can be effectively treated with topical retinoids like tretinoin. 1

What Are Milia?

Milia are:

• Small (1-4mm), white, hard, superficial epidermal cysts 2
• Filled with keratin (a protein found in skin)
• Usually asymptomatic but cosmetically concerning
• Most commonly appear on the face, particularly around the eyes, cheeks, and forehead

Milia can be classified as:

1. Primary milia: Occur spontaneously without prior skin damage
2. Secondary milia: Develop following skin trauma or disease 3
3. Multiple eruptive milia (MEM): A rare condition with sudden eruption of numerous milia 2

Distinguishing Features

To confirm that the white bumps are indeed milia:

• They appear as small, firm, white or yellowish papules
• They don't become inflamed or red unless irritated
• They don't change in size or disappear quickly on their own
• They are not painful or itchy
• They cannot be easily "popped" like pimples

It's important to differentiate milia from other conditions:

• Closed comedones (whiteheads): Connected to pores, softer texture
• Sebaceous hyperplasia: Yellowish, often with central depression
• Syringomas: Flat-topped, flesh-colored papules, often around eyes
• Xanthelasma: Yellowish plaques, usually on eyelids

Treatment Options

First-line Treatments:

1. Topical Retinoids:

   • Tretinoin is effective for treating milia 1
   • Apply a thin layer once daily before bedtime to affected areas 4
   • Start with lower concentrations (0.025%) if you have sensitive skin 5
   • Allow skin to dry completely (20-30 minutes) after washing before application 4
   • Expect possible temporary irritation, redness, or peeling during initial weeks 4

2. Gentle Exfoliation:

   • Use mild chemical exfoliants containing salicylic acid 6
   • Apply as directed, typically 1-2 times weekly
   • Avoid harsh physical scrubs that may irritate skin

Professional Treatments:

If home treatments are ineffective, consider:

1. Extraction:

   • Professional extraction by a dermatologist using a sterile needle or blade
   • Quick procedure with minimal discomfort
   • Low risk of scarring when performed properly

2. Microdermabrasion:

   • Mechanical exfoliation to remove superficial skin layers
   • May require multiple sessions

3. Chemical Peels:

   • Light to medium peels can help exfoliate skin and release milia
   • Should be performed by a professional

Prevention Strategies

To prevent recurrence of milia:

1. Proper Skincare:

   • Use non-comedogenic moisturizers and sunscreens
   • Avoid heavy, occlusive products, especially around the eyes
   • Maintain regular but gentle cleansing routine

2. Sun Protection:

   • Use broad-spectrum sunscreen daily
   • Wear protective clothing and hats when outdoors 4
   • Avoid excessive sun exposure which can damage skin

3. Regular Exfoliation:

   • Incorporate gentle chemical exfoliants into your routine
   • Don't over-exfoliate, which can irritate skin

When to See a Dermatologist

Consult a dermatologist if:

• Milia are widespread or rapidly increasing in number
• Home treatments haven't improved the condition after 6-8 weeks
• You're unsure if the bumps are actually milia
• The bumps become inflamed, painful, or change in appearance
• You have a history of skin cancer or other skin conditions

Important Considerations

• Avoid attempting to extract milia at home, as this can lead to scarring or infection
• Be patient with topical treatments, as results may take 6-12 weeks to become apparent 4
• If using retinoids, be diligent about sun protection as they can increase sun sensitivity 5, 4
• Discontinue any product that causes excessive irritation or allergic reaction

By following these guidelines, most cases of milia can be effectively managed with improved appearance over time.