What Are Those Tiny White Bumps?

Those little white bumps you get right below your eyes, on top of your cheekbones, or on other parts of your face? Those pesky bumps are called Milia (pronounced mill-ee-a). Singular - plural, same word (well, technically the singular is "milium", but no one uses it).  They're like tiny pearls underneath the first layer skin that won’t come out no matter how much you squeeze, unless you literally scratch the darn thing off your face. Please don't do that.

Whatever others might have told you, it’s not “calcium deposits” or acne breakouts. It doesn’t require two rounds of Retin-A or massive chemical peels (although there are those with a genetic propensity that do have luck with AHAs and some have even been helped with careful and monitored use of Retin-A). However I've seen way too many people with prescriptions renewed a thousand times before they asked their doctor why it doesn't seem to be working.  

So, what are these milia?

Photo by Dr. Alaa Saad via dermRounds

Milia are basically a response to excess rubbing and/or scratching.  Sometimes, eye products, moisturizers, and/or makeup removers that are too rich for your skin can get stuck just outside of pores and in between microscopic tears in your skin.  In addition, extreme dryness can also cause these tears.  But what I have found is that most of the time, the issue is microscopic scratching.  Wash cloths or towels used to remove leftover makeup, or mascara remover wipes that are too textured for the delicate eye area, can cause teeny-tiny tears that the skin has to repair.  The skin mixes dead skin cells with fats and waxes in order to repair and prevent further damage.  I think the idea is supposed to be, better for the bumps to get scratched than the rest of the skin.

Here's a great example of one of the crazier ways I've seen milia form.  

I used to have a client whose skin had a very compromised natural barrier, making her skin extra vulnerable to water loss.  This was on top of the fact that it produced very little oil.  In other words, her skin was genetically dry - it underproduced oil by nature.  This made her skin even more vulnerable to water loss.

When she first started coming to me for facials (this was before my specialty in acne), the milia on her upper cheeks were extensive, which was why she came to me.  As we got to know each other, I learned that she ran the Chicago Marathon almost every year, which meant a lot of running outside throughout the summer to train for it.  Well, after not being able to pin down what was causing the problem for some time, it finally dawned on me that sweating all day outside with very little oil produced for protection, the salt from her sweat would crystalize invisibly on her upper cheeks, so as she was wiping away the sweat from her cheeks and under her eyes, she was literally scratching her skin with the salt of her sweat!  With the right skincare and especially the right hydrators and moisturizers, getting those milia out stopped being like a spinning wheel, and we finally got her skin clear!

So, what to do?

• Be especially careful about how you remove your eye makeup! Use 100% cotton rounds with gentle, outward motions. In my skincare webshop, I carry a wonderful eye makeup removing sponge that is gentle enough even for people who wear contacts! The fact that it can be used with nothing but warm water to remove ALL non-waterproof makeup is really the best thing ever!

• The only people who should be using waterproof mascara are those who use eye drops 24/7, or who know they’re going to cry any second! If your mascara runs or smudges, it doesn’t mean you need waterproof, it just means you need to change brands to something that works! Keep your receipts and return what you don’t like.

• DO NOT use washcloths to wipe off makeup or even to wash your face! Washcloths are just way too rough.  Just use your good ol' hands.  If water dripping down your wrists and forearms drives you crazy, it's not crazy to wear terrycloth wrist bands while you wash.  Sure, they'll make you look like you're cos playing John McEnroe, but your skin will thank you, I promise.

• Milia can be removed only by puncturing, but please don’t do it yourself. Get a facial from a licensed esthetician or see a doctor.

In the meantime, if milia are a constant problem, we need to evaluate your eye creams, makeup removal techniques, and moisturizers. Please contact me so we can work together on your way to clear, radiant skin! :)

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