Milia or milium (singular) are small cysts that appear on the body. Milia in newborns mostly occur on their face, nose, or cheeks as tiny white bumps. These cysts are filled with keratin and are among the common skin issues in babies. Thankfully, it is a benign condition with no complications. It also has a good prognosis, and the cysts disappear as the baby grows older.
Read on to know more about milia, its causes, symptoms, types, diagnosis, and treatment. We have also included a few home remedies that may reduce their occurrence.
What Causes Milia In A Newborn?
Milia occur when dead skin becomes trapped within small pockets at the skin’s surface. The cells in the epidermis (outer layer of the skin) shed constantly. However, in some cases, dead skin cells and a protein called keratin produced by the skin cells become trapped in small skin pockets, leading to the formation of cysts known as milia (1).
The cause for the formation of milia in newborns is unknown. Genetic factors may lead to milia at birth, while a combination of genetic and environmental factors may cause milia in newborns and older babies.
Milia could also occur inside the mouth. They are known as Bohn nodules when they occur on gums and Epstein pearls when they occur on the mucosal layer of the palate (mouth’s roof) (2). These conditions are often considered different from milia on skin.
Milia are not to be confused with miliaria (heat rash or prickly heat), which occurs due to blocked ducts of sweat glands. Milia are also different from baby acne, which usually occurs due to other factors, such as hormonal changes and allergies.
Types Of Milia
Milia can be broadly classified into primary milia and secondary milia. Primary milia occur due to natural or innate anomalies of the skin, while secondary milia usually occur due to skin conditions, such as skin disorders and skin trauma.
Newborns mostly experience neonatal milia, which is a type of primary milia. It affects about 40-50% of newborns and often occurs in combination with Bohn’s nodules and Epstein pearls (3). Neonatal milia are benign, painless, and disappear by themselves. It is also called congenital milia since it is often present at birth.
Older babies and toddlers may experience juvenile milia, which could either be a primary or secondary form of milia. Primary juvenile milia could occur sporadically and disappear in weeks or months. Secondary juvenile milia could be associated with several conditions, including genetic disorders, such as Bazex–Dupré–Christol syndrome, Gardner’s syndrome, Rombo syndrome, pachyonychia congenital, and nevoid basal-cell carcinoma syndrome.
Signs And Symptoms Of Milia In Newborn
The characteristic sign of milia is the presence of white, pearl-shaped bumps on the skin. Each bump is usually no longer than a millimeter in diameter, although some could attain a diameter of three millimeters (4).
Milia are painless and do not cause any symptoms for the baby. The following are the various signs of neonatal and juvenile milia that parents may notice.
- The bumps are present at birth or may appear a few hours after birth.
- The number of milia can be few or many.
- Milia are commonly seen on the nose.
- Milia could also appear on the scalp, trunk, and face.
- It usually presents several weeks or months after birth.
- The bumps are commonly found on the forehead, cheeks, and eyelids.
- Milia could emerge as a row of bumps along the nasal crease.
- Some babies may display bumps in the diaper area.
Both neonatal milia and juvenile milia are painless. Frequent friction of clothing with milia may cause the skin around a milium to redden, while the head of the bump remains white. Babies with juvenile milia may have other skin or genetic disorders.
When To See A Doctor?
Most doctors will inspect the baby’s skin at birth to rule out any disorders and anomalies. If your doctor rules out any serious cause for congenital milia, there is nothing to worry about.
If you notice milia a few days after birth, observe the bumps for any changes in size. If your baby is feeding and sleeping adequately and is healthy, there is no need to be concerned about milia.
You may consult a doctor in the following scenarios.
- The number of bumps constantly increase
- Milia covers several parts of the body
- Rubbing or touching the milium causes discomfort to the baby
- The baby has other skin problems
- Milia emerged after skin trauma or injury
- The baby has fever, is not eating well, or does not sleep well
- Pustular discharge from skin
It is advised to not puncture or remove the milia by yourself at home. Consult a doctor if you have any concerns.
Diagnosis Of Milia In Newborn
A pediatrician or pediatric dermatologist can diagnose milia through visual inspection alone. In rare cases, the doctor may perform a skin biopsy — collecting a small skin sample with a needle for microscopic examination. A skin biopsy might be needed when the baby has other skin disorders or is unwell. In such cases, microscopic evaluation can help rule out other conditions (5).
Treatment For Milia In Newborn
Neonatal milia do not require treatment since they are not painful and not associated with concurrent pathologies. The bumps fade and disappear within a few weeks after birth without leaving any marks or scars.
Juvenile milia do not require treatment if they are painless and do not interfere with the baby’s essential activities, such as sleeping and feeding. If the baby has secondary juvenile milia in conjunction with other skin or genetic disorders, then treating those conditions may cure juvenile milia.
How To Prevent Milia In Newborn?
There is no way to prevent milia. Milia is found even in healthy full-term infants, thus gestational care does not seem to have any influence. If your baby is diagnosed with a genetic disorder in utero, you may discuss the prevention of its associated conditions, including milia, with the doctor.
Home Remedies For Milia In Newborn
You may consider the following home remedies to manage your newborn’s milia at home and keep the baby’s skin healthy (6).
- Keep your baby’s skin clean at all times. Use warm water with mild baby soap to clean your baby’s skin.
- Always pat your baby’s skin dry and never rub it dry since the baby’s skin is soft and delicate.
- Always use gentle skincare products meant for babies. Never use products meant for adults or older children on your baby.
- Do not apply any cream, lotion, powder on baby’s face.
Do not use products or over-the-counter medicines that claim to reduce milia. Milia do not leave marks on the baby’s skin and do not lead to any cosmetic problems.
Frequently Asked Questions
1. How long do a baby’s milia last?
Neonatal milia usually resolve within weeks after birth. Juvenile milia may persist for several weeks or months, especially in case it is associated with a skin disorder.
2. What if a baby’s milia won’t go away?
Consult a doctor if a baby’s milia do not go away. Persistent milia could be secondary juvenile milia due to skin or genetic problems. Treating any underlying condition usually may resolve milia.
Milia are common among newborns and seldom a cause for concern. Babies do not feel any pain due to them, and the bumps resolve without leaving any marks. If a baby’s milia appear inflamed, reddened, or the baby has other problems, seek medical advice. While you cannot prevent milia from occurring, you can keep your baby’s skin healthy through appropriate care.
2. Patricio P. Gallardo Avila and Magda D. Mendez, Milia; StatPearls; NCBI
3. Milium; DermNet NZ
4. Milia; Raising Children Network (Australia)
5. Milia: Diagnosis and Tests; Cleveland Clinic
6. What Are Milia—And How Do You Get Rid Of Them?; University of South Florida