Millium cysts - How to remove white bumps on the face?

Have you noticed that you are getting a lot of white bumps on your face and you don't know what to do about it? Possibly what you have are milliary cysts and they are a purely aesthetic problem that does not affect your health. However, if you want to get rid of them, there are ways to prevent and treat them.

Illustration of a woman presenting with multiple milliary cysts.

Milia cysts are also called closed comedones or milia and occur with great frequency in the general population. They are a frequent reason for my dermatological consultation and occur more frequently in the general population. frequently in patients with oily skin and/or who use very occlusive creams. 

Table of Contents

What is a millium cyst?

A millium forms at the base of a hair follicle or sweat gland. They are formed when keratin (a substance produced by the skin) is trapped under the outer layer of the skin, forming a small cyst that is hard to the touch and looks like a small white ball. 

Illustration showing the development of millium cysts.

These cysts occur spontaneously (primary) and others in response to a skin lesion (secondary). 

  • Primary millium cysts are formed directly from trapped keratin and usually appear on the face of infants and adults. In this article I will only discuss adult millium cysts, which typically develop on the eyelids, cheeks, forehead and even genitalia. 
  • Secondary millium cysts are also tiny cysts and look similar, but develop after something blocks the ducts leading to the surface of the skin, such as after a wound, burn or blister on the skin.

How to prevent millenium cysts from appearing?

There are many things we can do to prevent new millium cysts from appearing or even treat the ones we already have on our skin. If we see that these measures are not enough you will have to request a visit with your favorite dermatologist to remove them with an aseptic method. 

1- Do not squeeze!

First things first, never try to burst or squeeze a milium! 

Unlike the typical pustule of acne, the millium is a small cyst that has a capsule inside the skin. This is why the small white lump inside the milium is very hard. It is formed by a plug of dead keratinized (hardened) skin cells that have become trapped just below the surface of the skin.

No matter how hard you try, squeezing the milios will get you nowhere. That little bump is too hard, almost like a grain of sand. Since the little white balls form under a thin layer of skin and not in the pore (as is the case with acne pimples), there is no opening in the skin through which the plug can escape. 

If you keep squeezing, you will only inflame the skin and even leave scars for life!

 

Illustration of a woman squeezing pimples or millium cysts on her face.

2- Protect yourself from the sun

In the case of adults, chronic overexposure to the sun can be a very important factor in the development of these cysts. As a result, the skin has difficulty in expelling the keratin scales to the surface and these little white balls will form. 

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3- Avoid "greasy" creams

It is very important to avoid creams that can leave the face very oily and greasy. It is also important to avoid very dense foundations that can worsen the problem. 

If you have skin prone to the formation of millium cysts, avoid the following ingredients in creams:

  • Liquid kerosene wax
  • Liquid petroleum
  • Kerosene oil
  • Paraffinum liquidum
  • Liquid petroleum jelly
  • Petroleum oil

How to treat millium cysts?

In the case of infants that present millium cysts will not require any treatment, as they will go away on their own within a few weeks. 

In the case of primary or secondary milliary cysts in adults It is more difficult for them to disappear on their own and treatment is often necessary.

1- Creams to eliminate millium cysts

Instead of trying (unsuccessfully) to pull out a milium, you can start with an over-the-counter salicylic acid, glycolic acid or retinoid product.. These products help exfoliate the skin and help release pores that have become occluded by treating and preventing new milia from appearing. But be careful, these products cannot be used on the eyelids. In this case it is best to consult your dermatologist so that they can be removed.

However, be prepared for long-term use. Milia are very resistant and it may take months before you see any improvement.

Exfoliating creams

ZO Skin cream containing retinoids

The retinoids are very effective in exfoliating the skin and accelerating cell renewal.  Retinol can irritate the skin at first, so start using these products gradually.

 How to use it: Apply every night before going to sleep. Start a few times a week and then increase the frequency progressively until every night.

My favorites: 

Sebo-regulating soaps

Effaclar cleansing gel

If you also have oily or greasy skin, it will be necessary to include a sebum-regulating soap in your skin care routine.

How to use it: Apply every morning and evening with a light massage on the face and then rinse with water.

My favorites: 

2- Manual removal of cysts

If you have many millennials and they:

  • They have remained for a long time
  • Have not gone away with over-the-counter treatments
  • They are in a place that is difficult to treat (such as the eyelid).

The next step is to see a dermatologist!

Normally in our practice we make an incision in the skin over the milium with a sterile needle or with a lancet with a #11 scalpel. Then we remove the cyst with the help of a comedone extractor to perform in a non-traumatic way. 

Although millium cysts are found in the outer layers of the skin, they are difficult to remove without the proper material. Do not attempt to remove them at home, as you may leave a scar.

3- CO2 laser for milliums

The CO2 laser is another very effective method to remove millioma cysts. It is one of my favorite methods because it allows me to perform the removal with great precision and with the advantage that the millioma cysts do not reappear. It also allows us to safely treat delicate areas such as the eyelids. 

If the patient has few lesions it will be possible to do it without anesthesia and in the case of having many we put an anesthetic cream on the affected area before. 

4-Peelings and dermabrasion

Peels and dermabrasion have also been described for the treatment of milli cysts. It has worse response rates compared to previous treatments so it is not what I indicate in the first instance. They are usually reserved for when the extent and amount of millium is very high. 

Conclusions

If you are a person prone to developing white bumps on your face, you can try using the creams I recommend in this post. If, in spite of the correct prevention, the millimetric cysts persist, it will be necessary to go to your dermatologist for a professional extraction of the same. 

Attributions and bibliography

  • National Institutes of Health, U.S. National Library of Medicine, MedlinePlus. Milia. Updated February 26, 2021.

  • Cleveland Clinic. Milia. Updated October 22, 2018.

  •  Gallardo-Avila, et al. Milia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan. 2020 Oct 1.

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Sebastian Podlipnik - Skin cancer

Sebastian Podlipnik

Dermatology Blog

I am a dermatologist and cum laude MD and author of multiple research studies. I specialize in skin cancer, laser technologies and cosmetic dermatology. The intention of this blog is to bring you closer to topics of interest in dermatology and research.

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