The first tenet of good skin care, as any dermatologist will tell you, is to never, ever pick at your skin — even if you have a zit that's just waiting to be popped. Still, the fact remains that, when a pimple arises, most of us ignore MD advice and go straight to the squeezing. Playing Dr. Pimple Popper isn't advised, but if you've ever found yourself in a situation where even picking, popping, and squeezing just won't do the trick, it could be that your pimple isn't a pimple at all — it's a milial cyst.
Milia might look like little whiteheads, but they’re actually firm white bumps made of keratin protein that become trapped under the skin with no place to go. “Keratin is made in our skin cells and transported to the outer layer of our skin. Sometimes it get stuck in transit — that's basically what a milial cyst is,” explains Adarsh Vijay Mudgil, MD, dermatologist and Clinical Assistant Professor at Mt. Sinai Hospital in New York City.
So why can’t milia be popped like a zit? According to Joshua Zeichner, MD, dermatologist and Director of Cosmetic and Clinical Research in Dermatology at Mount Sinai Hospital in New York City, unlike blackheads and whiteheads that protrude to the surface of the skin, milia form under the skin without a connection to its surface — and that means no amount of picking will help.
As if that weren't frustrating enough, Dr. Zeichner says that milia can occur with any skin type (not even brand-new, smooth-skinned babies are immune) and for no known reason. “We don’t totally understand why they occur, but it is thought that sun damage and occlusive cosmetics predispose people to develop milia,” he says. "Sun damage leads to inflammation in the skin, which can block pores, while heavy cosmetics can directly block pores, increasing the risk of developing milia."
The good news? Milia tends to go away on its own, as the body sheds its outermost layer of skin cells to release the blockage. The caveat, Dr. Mudgil says, is that it can take months for the bumps to subside without dermatological intervention. For those who don’t have time for nature to run its course, there are options: "In the office, your dermatologist may use a needle to open them and extract the contents, similar to what is done for pimples," Dr. Zeichner says. But he cautions patients not to touch them at home: "Since they are not connected to the surface of the skin," he explains, "picking at them will cause more harm than good.”
Considering the various causes of milia aren't fully understood, preventing them can be a bit of a guessing game. As Dr. Zeichner mentioned, the pore-blocking powers of heavy cosmetics may be linked to possible milia development. But before you throw away that full-coverage foundation, a simple product swap may do the trick. “Mineral and powder foundations are less likely to block pores compared to liquid makeup,” he says.
And it’s not just your makeup bag that may need an overhaul: Dr. Zeichner says that rich, occlusive skin-care products, including eye creams, can also lead to milia forming near the eyes and on the cheeks. “If you tend to develop milia, stick to oil-free makeup and moisturizer,” he suggests. Adding a topical retinoid (to stimulate collagen production, reduce inflammation, and help clear pores) or exfoliating product with salicylic acid (which removes excess oil and sloughs off dead skin cells) into your routine may also help keep the little white bumps at bay. For those with sensitive skin, Dr. Zeichner says, a gentle physical exfoliator can assist.
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