It’s Not a Whitehead, It’s Milia—Here's How to Treat It

It’s easy to mistake them for whiteheads: Small, pale bumps that crop up overnight, clustered under the eyes, on the cheeks, or along the nose. But before you pick up your tweezers or get to squeezing them (bad!), listen up—what looks like a mild breakout or whiteheads could actually be milia, a completely different kind of skin concern that won’t respond to your tried-and-true acne spot treatment, and definitely not to squeezing.

“Milia are tiny cysts that sit just under the skin’s surface,” explains cosmetic physician and head of education at Acquisition Aesthetics Emmaline Ashley, MD. “They are full of a protein called keratin, which is commonly found in your hair, nails, and the outer layer of skin.” Milia presents itself as pearly-white bumps; however, they are not inflammatory, infectious, or even remotely related to acne.

Whiteheads, on the other hand, are a type of acne lesion caused by clogged pores that are filled with sebum, dead skin, and bacteria. “Milia, however, are firmer, deeper-set, and won’t extract easily like a whitehead,” warns Dr. Ashley.

What causes milia?

Our skin isn’t just a protective barrier. It’s a living, breathing organ that renews itself once a month. As part of this natural cycle, dead skin cells are meant to shed from the surface, making way for the fresh, healthy ones beneath. But sometimes, that process doesn’t go quite as planned, causing milia.

These tiny, pearly bumps form when dead skin cells and keratin become trapped beneath the surface, rather than exfoliating as they should. They most often appear around the eyes and cheeks, delicate areas where the skin is thinner, making them more susceptible to buildup.

“Clinically, milia are smooth, dome-shaped, and feel firm to the touch,” says Dr. Ashley. “Unlike a whitehead, they don’t come to a ‘head,’ they’re not red or inflamed, and they’re usually not tender or painful unless irritated.”

According to Hussein Yassine, MD, board-certified dermatologist and founder of Skin Expert Clinic, milia is often found in newborns and in adults with dry or damaged skin and can be triggered by multiple factors, one of them being the use of occlusive ingredients or very thick, hydrating formulas—they contribute by disrupting natural exfoliation.

“A lot of people consider petroleum jelly, like Vaseline, to be a moisturizer, which it is not,” he explains. “Not to forget the use of mineral oils, lanolin, beeswax, paraffin, and other rich natural oils, as well as cocoa and shea butter.” Even ingredients like dimethicone, commonly found in makeup, can contribute to congestion when layered too heavily. Overusing rich eye creams, failing to properly remove makeup, or relying on occlusive products in hot, humid climates can also create the perfect conditions for milia to form.

The Different Types of Milia

Milia is categorized into two general types: primary and secondary. Primary milia form on their own, explains Corinne Erickson, MD, board-certified dermatologist and owner of Georgia Skin Specialists, and are often seen on newborns as tiny white bumps or the ones that appear on adult eyelids and cheeks for no obvious reason. Secondary milia comes from skin injury, such as a burn, blister, scar, or certain cosmetic procedures, adds Celina Feldman, MD, board-certified dermatologist and assistant professor at the Icahn School of Medicine at Mount Sinai.

There are rarer forms of milia, such as milia en plaque, which Dr. Erickson says is a clustered patch on inflamed skin, and multiple eruptive milia, which are a group of cysts that form over the course of a couple of weeks to months on your upper arms, stomach, and your face and can sometimes be very itchy.

Where does milia happen?

You’re most likely going to find milia on the eyelids, the under-eye area, cheeks, nose, and forehead, says Dr. Erickson. But they can also show up on your ears, on the back of your hands, chest, and genital area. For newborns, milia can appear inside the mouth. For secondary milia, she says they are most likely going to show up at sites of trauma or inflammation.

How to Treat Milia

When it comes to at-home care, consistency is key. Gentle exfoliating ingredients can gradually help reduce milia and prevent new ones from forming. Look for formulas that include retinoids to boost cell turnover and minimize keratin buildup, as well as AHAs and BHAs—especially if you’re also managing acne or congestion. But tread carefully. “Because milia tends to occur around delicate areas like the eyes, it’s important to be careful,” warns Dr Ashley. “Avoid over-exfoliating and do not attempt to extract them yourself at home.”

Is milia harmful?

If you happen to have milia, there’s no need to panic. Milia are harmless, for the most part. “Ordinary milia are completely harmless,” says Dr. Feldman. “They don’t become cancerous, spread throughout the body, or cause systemic disease. They’re primarily a cosmetic concern.” If you’re experiencing widespread or unusual milia, she says that can be associated with an underlying skin disorder. That’s when she’d recommend you see a dermatologist.

Can you prevent milia?

Dr. Feldman says that there is no guaranteed way to prevent primary milia because they can occur spontaneously. But if you’re prone to getting them, she recommends avoiding heavy or occlusive products around the eyes, exfoliating your skin aggressively, and constant picking at your skin.

Experts also agree that maintaining a healthy skin barrier and committing to a consistent, but gentle, exfoliation routine can significantly reduce your risk. Choose non-comedogenic, lightweight products around the eyes, avoid heavy occlusives that trap dead skin and keratin, and consider incorporating a mild chemical exfoliant once or twice a week. Dr. Erickson says that you’ll also want to incorporate regular use of topical retinoids as well, to help promote skin cell turnover. “Always use SPF daily,” Dr. Ashley adds. “As chronic sun damage is a common contributor to primary milia in adults.”

When to Seek Professional Treatment

In most cases, milia is harmless and tends to resolve on its own with time. But if it’s persistent—or simply bothersome from a cosmetic standpoint—experts recommend a combination of consistent at-home care and professional in-clinic treatments. “A skilled clinician can use a sterile needle to gently de-roof the lesion,” says Dr. Ashley. “Cryotherapy, diathermy, or even laser ablation can be suggested for more extensive cases.”

Dr. Yassine also recommends retinol or an in-office peel to help regenerate the skin and boost exfoliation. “You can also opt for a series of HydraFacials—they’re one of the most effective treatments for deeply cleansing the pores,” he says.

Dr. Erickson adds that you should see a professional if you have multiple milia erupt at once, if they accompany a skin rash, are related to a medication your doctor prescribed, or if they really bother you. A dermatologist will be able to perform a quick in-office treatment to safely extract the milia. “Milia can be surprisingly stubborn to remove and self-treatment attempts may lead to scarring,” she says. “Resist the urge to perform bathroom surgery.”

Have a beauty or wellness trend you're curious about? We want to know! Send Vogue’s senior beauty & wellness editor an email at beauty@vogue.com.