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

Vogue

9 hours ago

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, Dr. Emmaline Ashley. '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 Dr. Hussein Yassine, 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.