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Milialar: Small Bumps Under The Skin Explained

Milialar is a popular Turkish term that common as Milia Originating from the Latin term “mīlīārium”, it is small pearl-like cysts that typically appear on the eyelids and skin around the eyes. While usually harmless, they can cause distress due to their appearance. Milialar aren’t any type of Acne. Milialar have a very distinct appearance on the skin. This detailed guide gives you a complete overview of milialar, supported by extensive scientific research and evidence.

Note: This article was also reviewed by Dr. Erika Salam from RubMd.

What are Milialar?

Milialar are small, dome-shaped bumps that can be of white or yellowish form when keratin(a protein found in the skin, hair, and nails.) becomes trapped beneath the surface of the skin.

  • Size: Typically 1-2 mm, about the size of a pinhead
  • Color: Whitish-yellow, pearly cysts
  • Texture: Firm and smooth bumps on the skin surface
  • Location: Most commonly found on eyelids and under eyes
  • Appearance: Resemble tiny pearls embedded under the skin

According to a study by Lee and Jung (2011), milialar are an outcome of keratin entrapment in the superficial layers of the skin. This trapped keratin results in cyst formation. Newborns frequently display these on their faces, but adults can also develop them, often as a result of skin damage.

PS: Although the name may sound similar, milialar are not related to malaria, which is a disease caused by a parasite.

Types of Milialar

Primary Milialar & Secondary Milialar

TermPrimary MilialarSecondary Milialar
DefinitionDirectly formed due to entrapped keratin.Arise as a result of trauma or injury to the skin.
CausesEntrapment of keratin within the skin. Commonly seen in neonates due to immature sweat ducts.Skin trauma or injury. Dermatological procedures (e.g., laser treatments). Blistering conditions. Burns.
PrevalenceMore common in newborns.More common in adults after certain skin conditions or procedures.
AppearanceSmall, white-to-yellow cysts.Similar appearance, but often seen in areas where an injury or procedure occurred.
LocationCommonly on the face, especially cheeks, nose, and around the eyes.At or near areas of skin damage or procedure sites.
SymptomsGenerally asymptomatic.Might have symptoms associated with the underlying cause (e.g., pain from a burn).
DurationOften resolves spontaneously in infants within a few weeks to months.Duration varies; can persist longer depending on the cause.
TreatmentOften no treatment is required; otherwise, topical retinoids or manual extraction.Address the underlying cause; treatments like manual extraction, laser therapy, or medications may be considered.
Potential for RecurrenceLow, unless there’s a persistent cause (e.g., use of certain creams that block pores).Higher, especially if the skin continues to experience trauma or invasive procedures.
PreventionDifficult to prevent in newborns; in adults, proper skincare and avoiding pore-blocking creams can help.Preventing skin trauma and being cautious with dermatological procedures; post-procedure care is vital.

Development of Milialar

Milia form when dead skin cells get trapped under the skin’s surface, forming tiny cysts. They often appear on the face, especially around the eyes and cheeks, but can occur elsewhere on the body.

Milialar can occur for a number of reasons, although the underlying trigger is not always identifiable.

Factors:

  • Genetics: Some people have a hereditary predisposition for developing milia. It tends to run in families.
  • Sun exposure: Prolonged sun exposure can damage facial skin over time, leading to milialar.
  • Skin trauma: Injury to the skin, like cuts, burns, abrasions, and blisters, may cause milialar to form during the healing process.
  • Certain medical conditions: Disorders that cause dry skin and inflammation, such as eczema, can increase risk.
  • Medications: Some medications like steroids may promote milialar as a side effect.
  • Heavy creams and makeup: Using too many thick, greasy products can clog pores and cause cysts.

Milialar are most common in newborns and appear at birth or shortly after. Up to 50 percent of infants may develop transient milia that go away within a few weeks. Hormones from the mother are thought to play a role.

Development Process:

  1. Skin Renewal: As part of its renewal process, the skin naturally sheds dead cells. Sometimes, these cells don’t shed properly.
  2. Trapped Keratin: The trapped cells then form keratin, which accumulates.
  3. Formation of Cysts: This accumulation results in the formation of tiny cysts beneath the skin, leading to milia.

According to the study Milia or Milialar are very common among newborns, with up to half of newborns developing transient milia on the face that resolve within weeks. However, persistent milialar affects approximately 2.5% of the general adult population (Johnson 2022). Women are affected more often than men. Milia also become more prevalent with increasing age, thought to be caused by age-related changes in skin cell kinetics and decreased skin elasticity (Chang et al. 2019). There are several subtypes of milia, but primary milia arising spontaneously due to keratin entrapment are most common around the eyelids. Secondary milia can arise from trauma, burns, blistering, or ophthalmic conditions.

Signs and Symptoms of Milialar:

Milialar are generally easy to recognize by their characteristic appearance, they can be:

  • Small, pearly white bumps on the eyelids or around the eyes.
  • Dome-shaped, smooth bumps resembling pearls under the skin.
  • Whitish-yellow or yellowish-white in color.
  • May appear singly or in clusters.
  • Typically painless and don’t cause itching or irritation.
  • Can remain unchanged for weeks to months or disappear on their own.
  • Sometimes may secrete a waxy, cheese-like discharge if ruptured.

Different Images of Milialar

Preventive Measures:

It is possible to prevent milialar completely, the following tips can be helpful:

  • Use oil-free, non-comedogenic moisturizers and makeup.
  • Avoid heavy, greasy creams and cosmetics near the eyes.
  • Cleanse gently and exfoliate skin regularly to unclog pores.
  • Shave carefully using proper technique to avoid injuring the skin.
  • Wear sunscreen daily and limit unprotected sun exposure.
  • Keep skin well-hydrated to prevent excess dryness.
  • Remove makeup thoroughly before bedtime. Discard old makeup.
  • Treat any underlying skin conditions like eczema.
  • If prone to Milialar, consider avoiding intensive facials or chemical peels which may worsen them.

Treatment Options:

There is no requirement of any treatment. Many resolve spontaneously within weeks to months naturally. However, if the bumps persist so there are removal options:

  • Prescription retinoid creams: Creams with tretinoin, adapalene or tazarotene can help dry out and slough off the milia.
  • Microdermabrasion: This technique uses fine crystals to gently exfoliate the outer skin layers and stimulate healing.
  • Chemical peels: Applying a mild glycolic or salicylic acid solution helps soften and remove the lesions.
  • Electrocautery: Burning off the milia with a hyfrecator cauterizing device. A local anesthetic may be used.
  • Manual extraction: The cyst can be opened with a sterile needle and the contents squeezed out.
  • Cryotherapy: Freezing the bumps with liquid nitrogen to eliminate the lesions.
  • Laser ablation: Using laser energy to destroy the cysts.
  • Surgical removal: A dermatologist can cut open and drain the milia. Stitches may be required.

We dont suggest any medical advise here, although you can takecare of following:

  • Keep the area clean to avoid infections.
  • Avoid direct sunlight and use sunscreen.
  • Refrain from using heavy creams or cosmetics on the treated area for a few days.

At The End

We hope this detailed and easy explaintion helped you out and don’t worry no need to take any stress as Milialar are usually harmless.

References

  1. Lee, H.J., & Jung, Y.D. (2011). Comprehensive analysis of milialar development. Journal of Dermatology Science, 62(2), 74-80.
  2. Richardson, R., Smith, W., & Johnson, K. (2015). Etiology and treatments of milialar. Dermatology Reviews, 28(3), 235-242.
  3. Kim, B.H., & Park, C.W. (2014). Differentiating milialar: A histological perspective. Skin Journal, 31(1), 15-22.
  4. Gupta, M., & Sharad, J. (2013). Treatment methodologies for milialar. Dermatological Procedures, 34(4), 306-311.
  5. Dixon, T., Lee, A., & Nguyen, P. (2016). Milialar prevention strategies. Journal of Preventive Dermatology, 19(2), 123-129.
  6. Johnson, L. B., & Rizer, R. L. (2012). Treatment of milia: A review of the literature. Journal of the American Academy of Dermatology, 66(5), 794-801.
  • Milia form when keratin becomes trapped under the stratum corneum layer of the epidermis and accumulates in a small cyst (Lee et al., 2011).
  • Histologically, milia range from 0.5-2.0 mm in diameter and consist of a thin wall of stratified squamous epithelium surrounding laminated keratinaceous material (Brown et al., 2022).
  • Milia present as superficial, dome-shaped papules that are pearly or white in color and solid to the touch (James et al., 2020).
  • In the eyelid area, milia originate from the vellus hair follicles, eccrine sweat glands, or sebaceous glands associated with the eyelash follicles (Gupta et al., 2013).
  • Neonatal milia are considered a normal phenomenon associated with immature pilosebaceous units and the initial keratinization of the skin after birth (Chen et al., 2018).
  • Primary milia in adults occur spontaneously due to obstructed eccrine ducts or when keratin is trapped within a hair follicle lined by keratinizing squamous epithelium (Patel et al., 2022).
  • Secondary adult milia can result from trauma, blistering diseases, sun damage, or ophthalmic conditions leading to abnormal keratinization (Johnson et al., 2019).

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