Have you noticed a sprinkle of tiny white or blueish bumps in the area under your eyes and wondered, Now what the heck is going on with my skin?! More than likely, what you're seeing is something called milia, a benign and very common condition that can affect people at any age. Before you start scrubbing or poking at them, listen to this advice about how to treat (and prevent) them, from dermatologist Mona Gohara, M.D., associate clinical professor of dermatology at Yale School of Medicine.
What are milia?
Milia are not a sign of anything serious, according to Dermatology Advisor. “I like to say milia are acne doppelgangers, but they’re not pimples,” says Dr. Gohara. “They’re really tiny cysts — specifically, cysts filled with keratin, which is skin protein — that can happen anytime from cradle to grave.” They’re super-common in newborns, says the Cleveland Clinic as almost half of all babies have these harmless bumps, and they tend to disappear on their own within a few weeks.
Milia can be the result of skin cells not exfoliating, Dr. Gohara says — but often, she adds, it has nothing to do with that. “Milia can come out in areas of trauma, or from using too many occlusive cosmetic products or as a sign of aging. And sometimes people just genetically have them.”
Knowing that milia can stem from trauma, it’s easy to understand why they have a tendency to conglomerate in the under eye area, says Dr. Gohara. “Often they’re from sun damage, which is the ultimate form of trauma to the skin. And one of the places that we age more readily and more quickly is around the eyes.”
Another cause, she adds, can be the overuse of occlusive eye creams.
First and most important, says Dr. Gohara: Wear sunscreen to help prevent the damage that can lead to milia. “Second, I suggest the use of retinols,” she says. “That’s a little tricky around the eyes, because there’s an increased tendency in that area towards the irritation that retinols can cause."
But Dr. Gohara says she tells her patients to divide their face into four quadrants: the forehead, chin, the right side of the face and the left side, with an imaginary line drawn down the center. Then, take a pea-size amount of a retinol product and divide it around your whole face, so you’re just using a quarter of that amount in each quadrant. "When you include your under-eye area as part of that, there’s less chance for irritation.”
First of all, “Don’t try to pop the damn things!” says Dr. Gohara. “They’re not pimples, and this won’t make them go away. If you try to pop them or pick at them, it’ll just create more trauma. And if you throw acne products on them—say, products with benzoyl peroxide or salicylic acids—you may just create irritation." She says you can try to gently exfoliate, though it may not make a difference.
Healthwise, you don’t have to get rid of milia, research says, and they’ll sometimes go away on their own. But if you’re bugged by the look of them, it’s best to let a dermatologist deal with the issue because the under-eye area has thin skin—and it’s near, you know, your eyeballs!
“One of the things dermatologists do is to extract milia manually with a little needle and something called a comedone extractor, and that’s tricky to do on your own,” says Dr. Gohara. “For a dermatologist, though, it’s a pretty easy procedure. There are also people who do this procedure in spas, but for the area near the eyes, I’d suggest a dermatologist, because this is delicate skin—and that’s a delicate organ right nearby!” Another option for removal, says Dr. Gohara, is laser ablation, a technique in which a laser is used to gently zap the cysts.
Bottom line: Milia are not bad for your health in any way, even those in the under-eye area—they're purely a cosmetic issue, and they may go away on their own. If they persist, or if you are simply bothered by the way they look, talk to a dermatologist about the best way to treat them for your particular skin.
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