What do the bumps look like?
| Feature | Milia | Sebaceous hyperplasia |
|---|---|---|
| What forms the bump | A small cyst containing keratin | An enlarged sebaceous gland, which produces oil |
| Colour | Usually pearly white; sometimes yellow | Skin coloured, yellow or brown |
| Surface clue | A tiny bump just beneath the skin surface | Usually a small dent or pit in the centre |
| Common locations | Eyelids and cheeks; also the forehead | Forehead, cheeks, nose and chin; also the upper chest |
| Who gets them | Children and adults of any age | Anyone, but more common in middle age and people with suppressed immune systems |
| Natural course | Can clear within weeks, but can persist for months or longer | Can return after treatment |
Location and colour overlap, so a white or yellow facial bump does not settle the question. Sebaceous hyperplasia can resemble basal cell carcinoma, a skin cancer. A dermatologist can examine the central pit with a dermoscope, a magnifying instrument that reveals the gland pattern and small blood vessels. Occasionally, a biopsy is needed to confirm the diagnosis.23
Why do they appear?
Milia develop when dead skin cells become trapped beneath the surface. Some appear after injury, burns or blistering, and some follow the use of heavy creams or ointments. Milia are not whiteheads or another type of acne. Sebaceous hyperplasia involves an overgrowth of cells in an oil gland; hormone changes can contribute to that growth.24
A cluster of milia on a raised, inflamed patch can be a rare form called milia en plaque, often found behind an ear or on an eyelid, cheek or jaw. That is a different presentation from scattered individual cysts and deserves an assessment rather than being treated as ordinary clogged pores.15
Do they need treatment?
Confirmed milia and sebaceous hyperplasia do not need treatment unless they bother you, even if a magnifying mirror has promoted them to a major project. The treatment choice depends on which kind of bump you have, how many there are and whether you want them removed.12
For milia, waiting is reasonable: some clear within weeks, while others persist for months or longer. A clinician can open the cyst with a sterile needle or blade and remove its contents. Topical retinoids, medicines related to vitamin A, may help widespread milia. Freezing and other procedures are also options; extraction is commonly used for milia en plaque.15
For sebaceous hyperplasia, options include electrosurgery, freezing, laser treatment and other medical procedures. Prescription medicines such as oral isotretinoin are another option to discuss with a dermatologist. Bumps often recur after electrosurgery, and they can return after medication stops. Removing an individual bump does not prevent new ones elsewhere, so removal does not put the remaining glands into retirement.23
What can you do at home?
Do not squeeze or scrape milia: that can cause infection or permanent scarring. Wash gently, pat dry and use sunscreen outdoors. Adult exfoliating treatments are an option to discuss if milia persist. Do not attempt freezing, burning, cutting or scraping sebaceous hyperplasia at home. Those are medical procedures, not extensions of a skincare routine.24
Newborn milia usually disappear in the first few weeks without treatment or lasting effects. Do not use adult lotions or oils on a baby's skin.46
When should you get a bump checked?
Have a bump assessed if it keeps growing or becomes an open wound that does not heal. Arrange a visit if presumed milia worsen or have not improved after a few months. An examination can distinguish these bumps before you choose treatment.24
Where this answer comes from
- 1Milium, miliadermnetnz.org
- 2Sebaceous Hyperplasia: Diagnosis, Symptoms & Treatmentmy.clevelandclinic.org
- 3Skin coloured lumps and bumpsdermnetnz.org
- 4Milia (Milk Spots): Causes & Treatmentmy.clevelandclinic.org
- 5Multiple white papules on the retroauricular foldpmc.ncbi.nlm.nih.gov
- 6Milia: MedlinePlus Medical Encyclopediamedlineplus.gov
