White spots under the eyes, commonly known as milia, are small, white cysts that appear on the surface of the skin. They are filled with keratin and usually form in clusters around the eye area, although they can occur on other parts of the face or body. We frequently encounter patients who are concerned about these stubborn white bumps. While they are harmless, they can be cosmetically unappealing and sometimes mistaken for other skin conditions.

We will explore what causes these white spots, how to differentiate them from other conditions, and the treatment options available. Understanding more about milia and how to effectively manage them can help you maintain a smoother, clearer complexion around the delicate eye area.

What Are Milia?

Understanding Milia

Milia are tiny, white or yellowish cysts that develop when dead skin cells (keratin) become trapped beneath the skin’s surface. Unlike whiteheads, which are caused by clogged pores, milia do not form in hair follicles but within small pockets in the upper layer of the skin called the epidermis. They are most commonly seen around the eyes, cheeks, and nose but can also appear on the neck and chest.

Types of Milia

There are several different types of milia:

1. Primary Milia: These appear in newborns and adults alike and are often found on the face. In infants, primary milia typically resolve on their own within a few weeks.
2. Secondary Milia: This type forms in response to skin trauma such as burns, rashes, or blistering. The damage to the skin causes dead cells to become trapped during the healing process.
3. Juvenile Milia: This rare form is associated with genetic conditions and syndromes that affect the skin, such as Gardner syndrome.
4. Milia En Plaque: A rare type that appears on inflamed or altered skin and is sometimes associated with autoimmune disorders.

Why Do Milia Form?

Milia are the result of trapped keratin beneath the surface of the skin. This can happen due to several factors:

1. Thickened Skin: People with thicker skin are more prone to developing milia, particularly around the eyes where the skin is already thin.
2. Sun Damage: Long-term exposure to ultraviolet (UV) rays can cause the skin to become thickened and leathery, increasing the likelihood of milia formation.
3. Heavy Skincare Products: Using products that are too rich, such as thick creams or oils, can clog the pores and lead to the formation of milia.
4. Medical Conditions or Skin Trauma: Burns, blisters, or long-standing rashes can disrupt the normal shedding of dead skin cells, leading to secondary milia.

Symptoms of Milia

How to Identify Milia

Milia typically appear as small, hard, white bumps on the skin. They are usually painless and do not cause any itching or discomfort. They can range in size from 1 to 2 millimetres and often appear in clusters. Around the eyes, they may be mistaken for other conditions such as syringomas or xanthelasma, which makes it important to get an accurate diagnosis from a professional.

Conditions that Resemble Milia

Some skin conditions can mimic milia, making it harder for patients to differentiate between them. These include:

• Whiteheads: Whiteheads form due to clogged pores and often have a different texture compared to milia.
• Syringomas: These are benign sweat gland tumours that appear as small bumps around the eyes and cheeks.
• Xanthelasma: Soft, yellowish plaques that usually indicate high cholesterol levels.

Treatment Options for Milia

Do Milia Go Away on Their Own?

In some cases, milia will resolve on their own, particularly primary milia in newborns. However, for adults, these cysts can persist for months or even years if left untreated. Secondary milia, which form due to trauma, may also resolve as the skin heals.

Professional Treatments for Milia Removal

If milia are a cosmetic concern, there are several effective treatment options available:

1. Manual Extraction: A dermatologist can safely extract milia using a sterile needle or a fine-tipped tool. This should always be done by a professional to avoid scarring or infection.
2. Chemical Peels: Mild chemical peels containing glycolic acid or salicylic acid can help exfoliate the skin and reduce the occurrence of milia.
3. Laser Therapy: Non-ablative laser treatments can help target milia without damaging the surrounding tissue.
4. Topical Retinoids: Retinoids help speed up cell turnover, which can prevent the formation of new milia and help resolve existing ones.

Preventing Milia

Skincare Tips to Prevent Milia Formation

While some people may be genetically predisposed to milia, there are several steps you can take to reduce your risk:

1. Exfoliate Regularly: Use gentle exfoliants, such as products containing alpha hydroxy acids (AHAs) or beta hydroxy acids (BHAs), to remove dead skin cells.
2. Avoid Heavy Skincare Products: Choose non-comedogenic moisturisers and sunscreens to prevent pore clogging.
3. Protect Your Skin from Sun Damage: Wear sunscreen daily to prevent sun-induced skin thickening.
4. Use Retinoids: Retinoid creams can help increase cell turnover and prevent the formation of milia.

Can Diet Play a Role?

While there is no direct link between diet and milia formation, a balanced diet rich in antioxidants and low in processed foods can support overall skin health. Foods such as berries, green vegetables, and fatty fish can promote healthier skin.

When to See a Skin Doctor or Dermatologist

If milia are persistent or cause cosmetic concerns, it’s best to seek the advice of a skin specialist or dermatologist. A professional can offer tailored treatment options and ensure the removal process is performed safely, without damaging the surrounding skin.

Final Thoughts

Milia, while harmless, can be a frustrating cosmetic issue. Fortunately, with the right treatments and preventive measures, you can keep your skin clear and free from these white spots. Whether it’s through professional extraction or incorporating certain skincare products, addressing milia can greatly improve the appearance and texture of your skin around the eyes. If you are concerned by white spots under the eyes book a consultation with the team at CLNQ today.