How to get rid of milia: Causes, treatments, and preventive measures as told by Singaporean dermatologists

How to get rid of milia: Causes, treatments, and preventive measures as told by Singaporean dermatologists

Expert opinion

Text: Emily Heng

Commonly mistaken for whiteheads and pimple pustules, we'd liken milia to the unholy amalgamation of both. Sure, it may look like a whitehead, but it hardly ever presents itself as a single, solitary bump. Rather, it emerges in a cluster that is typical of pustules. In sum: it is a series of raised, white bumps that — while painless! — have a ridiculously persistent presence upon your complexion. How did they get there? Is extraction the only reliable method of removal? And, for the love of God, how can you prevent it from becoming a regular occurrence? These are weighty questions as any, all of which is best addressed by the professionals. Hence, we called upon Singapore's top local dermatologists to dish the dirt. Take it away, folks.

What is milia, exactly?

Dr Teo Wan Lin, dermatologist and founder of TWL Specialist Skin & Laser Centre, says it best. "Milia seeds are actually tiny cysts that consist of protein in the skin known as keratin," she offers. "They are often found in clusters, and so are commonly referred to as milia."


How are milia seeds formed?

Milia seeds are formed when keratin — that's protein found in the skin, hair, and nail cells — become trapped under the epidermis. "It is commonly found by the nose, cheeks, and along the eye area," Dr Teo elaborates. "In terms of what specifically causes it, there are different types of milia that affect people from different age groups. There's infantile acne, which is due to transmission of hormones from the mother in the birth process. When it comes to adults and older children, on the other hand, one has to consider any existing trauma to skin, such as through resurfacing or laser treatments. Blistering injuries or even an over-usage of steroid creams can lead to milia formation, too."

What is the best way to get rid of milia seeds?

The general consensus seems to be through:

  1. Creams such as topical retinoids
  2. Chemical peels
  3. Prick and express or extraction
  4. Electrocautery

"Different methods are used depending on the location, number, size and depth of the milia, age of the patient, and patient preference," Dr Stephanie Ho, accredited dermatologist and founder of Stephanie Ho Dermatology, says. "Numbing cream or a quick numbing injection can be used to make the procedure very comfortable, even around sensitive areas such as eyelids. My personal favourite is to simply prick the milia with a sterile needle and to extract the contents of the milia after adequate numbing. The tiny wound that remains heals very quickly with barely any downtime and no scarring. In order to avoid infection and scarring, do seek help from a professional to have this performed quickly, safely and effectively.


Can you remove milia seeds safely from home?

Yes, though it's not entirely recommended. "I don't advocate DIY methods, or even going to non-medical professionals to get it removed," Dr Teo elucidates. "I understand that removal is commonly done by beauty therapists, but I find that there are a lot of potential dangers there. Yes, the needle might be brand new, but it's not auto-claved. That being said, if you have access to a very low-dose prescription retinoid, you can use it very cautiously and monitor for improvement."

Dr Stephanie Ho, however, warns that while light exfoliation or the use of retinoid-based products can get the job done, it may cause irritation and rashes in sensitive skin individuals. "Plus, it's not recommended for use around sensitive areas such as the eyelids, which is unfortunate since that's where a lot of milia gather," she points out.

Are there any preventive measures one can undertake to prevent the growth of milia seeds?

It's a resounding yes on this front. "Start with a gentle scrub once per week. Exfoliating can prevent growth," Dr Huimin Liew, consultant dermatologist of SOG — HM Liew Skin & Laser Clinic (a clinic by Singapore O&G Ltd.), advises. "A low potency strength of retinol can be used as well, but bear in mind that it can irritate your eyes if you have sensitive skin. Take stock of your current facial regime and swap out anything that it too rich of oily. Oh, and of course, sun protection is highly recommended."


Can milia seeds disappear naturally on their own?

"Those that are very close to the surface of the skin can resolve naturally on their own as part of the skin natural shedding process," Dr Ho says. "Milia in babies, for instance, are often left alone as these will usually resolve spontaneously."

It also should be noted according to Dr Liew that milia, in itself, is harmless. "It's just not aesthetically pleasant. Quite often, tiny ones simply disappear on their own, so taking action is not always necessary."