The Best Ways to Treat MiliaMedically reviewed by a board-certified physicianUpdated May 12, 2019Milia, those pearly bumps that are sometimes called whiteheads, are very common non-inflamed blemishes. Even if you aren't prone to inflammatory acne, you can still develop milia. There's generally no medical reason to treat milia. If they aren't really bothering you, there's no need to worry about them. You can just leave them be. Still, most people are annoyed by them enough to want to get rid of milia. If you're done with those pesky white bumps and want them gone, there are things you can do to treat milia. Ways to Treat Milia
First things first, never try to pop or squeeze a milium. Milium is the singular form of milia. So, you have one milium or many milia. The contents of milia are not fluid like the contents of a pustule. Pustules, those other whiteheads that are your typical pimples, are filled with a soft core of dead skin cells, sebum, and pus. So, when you put pressure on a pustule, the fluid contents often easily flow from the pore. (For the record, you really shouldn't be popping pustules either.) Unlike a pustule, a milium is not an acne pimple but rather a tiny cyst. The little white lump that makes up a milium is very hard. It's made of a plug of keratinized (hardened) dead skin cells that have become trapped just below the surface of the skin. Try as you might, squeezing at milia will get you nowhere. That little bump is simply too hard, almost like a grain of sand. Because milia form under a thin layer of skin and not in the pore (like acne blemishes do), there is no opening in the skin by which the plug could escape anyway. Squeezing at milia will just give you a tender, red spot and quite possibly damaged skin, and the milia will still be there.
Instead of trying to (unsuccessfully) pop out a milium, you can start off with an over-the-counter salicylic acid or glycolic acid product. The acne treatment medication Differin (adapalene) can also help. These products help exfoliate the skin. If you have just a few little bumps here and there, an over-the-counter product may be all you need to get the results you're looking for. Be ready to use them for the long haul, though. Milia are stubborn, and it can take months to see any improvement. If you have lots of milia, if they've been around for ages even while using over-the-counter treatments, or if they're in a spot that's difficult for you to treat with over-the-counter products (like your eyelid), then the next step is to see a dermatologist.
If you're prone to developing milia, and some people just are, your dermatologist may recommend using a topical retinoid. Topical retinoids help the skin to exfoliate effectively. When dead skin cells are sloughed away more rapidly, it can help prevent plugs of keratin from getting trapped beneath the skin's surface. Topical retinoids also help loosen the keratin plug in existing milia and help them come to the surface so they can go away.
The best treatment for milia is manual extraction done by a professional. It's the most effective, and the results are immediate. During the procedure, a tiny opening is made in the surface of the skin with a small surgical blade called a lancet. The hard plug of material that makes up the milium is gently pushed out through the opening with the technician's fingers or a tool called a comedone extractor. This procedure is sometimes called de-roofing. Although it sounds horrid, it's truly not that painful. No anesthetic is needed; at worst, you'll feel a prick. Most often, milia extractions are done at the dermatologist's office. In some cases, milia extractions may also be done by an esthetician at a salon or skin spa. Some states don't allow estheticians to pierce the skin, though, so legally they can't remove milia.
A quick word of warning—do not try to self-extract milia. You could do some serious damage to your skin, especially around the delicate eye area, and it can cause permanent scarring. Because milia are, the vast majority of the time, just a cosmetic issue, the choice to treat them or not is up to you. Treatment isn't necessary, and they can and do go away all on their own over time. If milia bother you, though, there are treatments that can improve them. Just be aware they take time, often several months, to really clear them. A side note, there are other things that cause white bumps on the skin. Unless you're 100% sure it's milia, you may want to have your bumps checked out by your physician.
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