Milia (Milium) ICD-10: L72.0

Benign skin lesion / Keratin cyst

Often searched as: tiny white bumps under skin, white dots on face, small white bumps around eyes, white bumps on eyelids, hard white spots on cheeks, milia on newborn face, baby white spots face, white bumps that won't pop…

Clinical urgency level

lowmediumhigh

Systems Affected

skin

Severity Levels

mild

A few small milia on the face (eyelids, cheeks), stable and asymptomatic — self-resolving in weeks to months, no treatment required.

moderate

Multiple milia persisting for months, cosmetically bothersome, covering larger facial areas — responds to gentle extraction by a professional aesthetician or dermatologist.

severe

Extensive milia associated with a blistering skin condition (epidermolysis bullosa, pemphigus) or genetic syndrome — requires underlying condition management alongside milia treatment.

Red Flags

Numerous milia appearing suddenly in an adult with no prior history — possible secondary milia from an underlying blistering condition
Milia associated with skin fragility, blistering, or scarring
Large or unusual-looking white cysts that don't match classic tiny 1–2mm milia — consider epidermoid cyst or other lesion
Milia in a newborn that persist beyond 3 months

Clinical Presentation

Milia — multiple small pearly white keratin cysts on the cheeks

Source: Wikimedia Commons (CC BY-SA 3.0 )

Milia image gallery — DermNet NZ

View gallery on DermNet NZ (image gallery reference)

When to See a Doctor

Milia in newborns are normal and resolve on their own within weeks — no treatment needed. In adults, see a dermatologist if milia are numerous, persistent beyond 3 months, cosmetically bothersome, or appear suddenly in large numbers. Do not attempt to pop or extract milia at home — this can cause scarring.

Differential Diagnosis

Closed comedones / whiteheads (acne — different origin, often with oiliness)
Syringoma (slightly larger, flesh-colored, around eyes — sweat duct origin)
Sebaceous hyperplasia (yellowish, enlarged pore in center — oil gland)
Molluscum contagiosum (central dimple, larger)
Epidermoid cyst (larger, may have visible pore, may become inflamed)
Xanthelasma (yellowish flat plaques around eyelids — lipid deposits)

Comorbidities

Epidermolysis bullosa (secondary milia from blistering)
Pemphigus or bullous pemphigoid (secondary milia after healing)
Porphyria cutanea tarda (secondary milia on sun-exposed skin)
Gardner syndrome (multiple milia + other cysts — genetic)

Prognosis

Primary milia (spontaneous) are entirely benign and self-resolving — most disappear within 4–8 weeks in newborns and within months in adults without treatment. They leave no scars. Secondary milia (after trauma or skin conditions) may persist longer and often require professional extraction. Topical retinoids can prevent recurrence by promoting normal skin cell turnover. There is no risk of malignant transformation.

Detailed Overview

Causes, Symptoms, and When to Take Action Milia are benign, small epidermoid keratin-filled cysts that commonly appear as pearly-white bumps just below the skin surface. These harmless lesions often resolve on their own but may sometimes require evaluation. How It Looks Texture: Firm, smooth, dome-shaped papules Color: Pearly white or yellowish Shape: Tiny, round or oval papules, usually 1–2 mm in diameter Location: Most frequently found on the face — especially eyelids and cheeks — but can also appear on the upper trunk, extremities, or genital area Why Does It Appear? Primary milia: Arise spontaneously from hair follicle structures (e.g., in newborns or associated with genetic conditions). Secondary milia: Develop following skin trauma, inflammatory skin conditions, or procedures like dermabrasion or blistering. Should You Be Concerned? Milia are harmless and typically resolve without treatment. However, it's worth consulting a healthcare provider if: The lesions persist beyond several weeks or months They become numerous or unusual in distribution You suspect they are part of a broader skin process or syndrome Can You Prevent It? There's no guaranteed prevention for milia, but minimizing skin trauma and careful skincare can help reduce their occurrence. 👉 How Piel AI Can Help Piel AI allows you to track milia over time through regular imaging. While it cannot diagnose, it helps you observe progression or resolution and supports discussions with medical professionals. Summary Milia are benign, keratin-filled cysts that appear as small, firm white papules. They may occur spontaneously (primary) or after skin injury (secondary). Generally harmless and self-resolving, but persistent or atypical cases warrant evaluation. Monitoring via imaging can aid awareness and professional communication.

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