How do milia differ from keratosis pilaris?
Both involve keratin, the protein that helps form skin, hair and nails. In keratosis pilaris, keratin accumulates inside hair follicles rather than shedding normally. In milia, trapped skin cells form small cysts beneath the surface. The distinction is a follicle plug versus a cyst, despite names that sound like rival skincare holding companies.134
| Clue | Keratosis pilaris | Milia |
|---|---|---|
| Appearance | Patches of small bumps, often skin coloured, red or brown | Tiny pearly white or yellow bumps, individually or in groups |
| Texture and symptoms | Rough, dry skin that can itch; bumps are usually painless | Small cysts that usually cause no pain or discomfort |
| Common locations | Upper arms, thighs and buttocks; the face can also be affected | Eyelids, cheeks, forehead and nose; other sites are possible |
| Who gets them | Often begins in childhood and becomes more noticeable during adolescence | Common in newborns, but can occur at any age |
| Usual course | Often lasts for years and can become worse in winter | Can clear within weeks, but adult milia can persist for months or longer |
Location alone cannot settle the question: keratosis pilaris can affect the face, and milia can occur on the arms. Roughness across a patch points more toward keratosis pilaris; distinct pearly white bumps point more toward milia. Neither condition is contagious. Milia are not whiteheads or another form of acne.1456
What should you do for keratosis pilaris?
Treat keratosis pilaris if dryness, itching or the appearance bothers you. Moisturizing and gentle skincare can soften the bumps and improve dryness. Treatment controls keratosis pilaris rather than curing it, so a product promising a permanent exit is getting ahead of the paperwork.7
- 1Wash with mild, unperfumed bathing products and cool or lukewarm water. Keep showers short, ideally 15 minutes or less.
- 2Apply a creamy moisturizer within 5 minutes of bathing, while skin is still damp. Urea or lactic acid are common choices. Apply moisturizer at least 2 or 3 times daily.
- 3If exfoliating, use a washcloth or mitt gently. Avoid harsh scrubs, scratching and picking.
- 4For persistent bumps, discuss an exfoliating treatment with a dermatologist. Options include salicylic acid, glycolic acid, urea and retinoids. Use the advised amount and frequency; stop the exfoliating medicine for a few days if dryness or irritation develops.
If your treatment plan has not helped after 4 to 6 weeks, tell your dermatologist. Some people need several treatment attempts. Once bumps improve, continued moisturizer or less frequent use of prescribed treatment can help maintain results. Natural clearing can take years.7
What should you do for milia?
Leaving milia alone is a valid option. Newborn milia usually disappear during the first few weeks without treatment or lasting effects. Adult milia can clear within weeks to months, although some persist longer. Wash gently and pat dry. Do not use adult lotions or oils on a baby's skin.46
Do not squeeze, scrape or try to remove milia with a needle at home: this can cause infection or permanent scarring. If you want removal, a clinician can open the cyst with a sterile needle or blade and remove its contents. Topical retinoids may help widespread milia; discuss treatment with a clinician rather than treating eyelid bumps yourself.24
Some milia develop as injured skin heals, including after burns or blistering rashes. Certain topical medicines can also be associated with milia. If bumps appeared after a skin injury or during prescribed treatment, mention that history at your appointment.2
When should you get the bumps checked?
A clinician can usually distinguish these conditions by examining your skin. Get advice if you are unsure, the bumps hurt, or the skin becomes itchy or inflamed. For milia that worsen or do not improve after a few months, arrange an appointment. For troublesome keratosis pilaris that home care has not helped, a pharmacist can suggest creams and tell you whether to see a doctor.3456
Where this answer comes from
- 1Keratosis Pilaris: Symptoms, Causes, and Treatmentdermnetnz.org
- 2Milium, miliadermnetnz.org
- 3Keratosis Pilaris: What It Is, Causes, Symptoms & Treatmentmy.clevelandclinic.org
- 4Milia (Milk Spots): Causes & Treatmentmy.clevelandclinic.org
- 5Keratosis pilarisnhs.uk
- 6Milia: MedlinePlus Medical Encyclopediamedlineplus.gov
- 7Keratosis pilaris: Diagnosis and treatmentaad.org
