Milium (horny cyst, whitehead, “millet”) is an epidermal cystic formation at the mouth of the hair follicle, looking like a small white grain. Typically, milia are localized on the face in areas with relatively thin skin, very rarely on the body, and exist for a long period without any changes. Milia are a fairly common cosmetic problem and can occur at any age. Whiteheads appear especially often during puberty; also often found in newborn babies (neonatal acne). Female representatives are more susceptible to the appearance of milia.
What are closed comedones?
Closed comedones are non-inflamed cysts that arise as a result of the accumulation of sebaceous gland secretions at the mouths of the sebaceous gland duct. Normally, skin secretions freely come to the surface of the skin without getting stuck in the ducts.
Closed comedones are not amenable to simple mechanical extrusion, because... have no free exit. In essence, it is a sebaceous plug that has no exit through the natural sebaceous duct.
They are located in seborrheic areas, most often in the forehead and cheeks.
Read about the causes of increased oily skin and how to reduce sebum production here.
How are closed comedones formed?
The mechanism of formation of white comedones involves 2 disorders:
- Follicular hyperkeratosis is a violation of the exfoliation of keratinized cells that linger and narrow the excretory ducts. Normally, dead skin cells are exfoliated both from the surface of the skin and from inside the pores. If the excretory duct of the sebaceous gland (pore) is narrow, then the exit of the contents becomes impossible and a blockage forms.
- Changes in the composition of sebum also contribute to the formation of blockages. With a denser and thicker secretion of the sebaceous glands, glued together by scales, its exit to the outside is difficult.
Symptoms
A pimple on the eye on the lower or upper eyelid can be of different sizes, consistency and shape. It is worth remembering that milia (a small rash that spreads quite quickly) is one of the less dangerous neoplasms, unlike the case when a pimple appears on the mucous membrane of the eye.
In addition to the neoplasm itself, other symptoms may be present near the eye. For example, very often the affected area begins to itch and hurt, and a purulent watery secretion is released from the pimple. In many cases, there are general signs of an inflammatory process in the body. These include:
- significant increase in body temperature;
- increased fatigue;
- general weakness;
- lack of appetite;
- deterioration of general condition.
All these signs are absent in millet grass, which is caused by viral pathogens such as gonococcus and herpes virus.
If a white pimple appears on the surface of the eye shell, a person may complain of lacrimation and purulent discharge from the eye.
A white pimple under the eyelashes, as a rule, does not have symptoms of an inflammatory process. Its appearance is influenced by excess body weight and oily skin type. However, with an infectious or viral etiology of this phenomenon, general weakness, apathy and elevated body temperature may be observed.
Causes of white comedones
Why does hyperkeratosis form and changes in the amount and composition of sebum:
- According to medical research, the most common cause is hormonal imbalance .
Other reasons:
- Genetic predisposition
- Improper facial hygiene and cosmetics used
- Side effect of drugs
- Diet disorders and gastrointestinal diseases
It is rarely possible to establish the true cause. If possible, you need to pay attention to the list above and try to eliminate the root cause.
However, white comedones will not disappear on their own; external influence is necessary to get rid of them.
Is it possible to remove white spots on the skin around the eyes on your own?
Doctors give a categorical answer “no” to this question. Under no circumstances should you try to get rid of small spots under the eyes at home. Such attempts will still not lead to the desired result. Firstly, it is almost impossible to squeeze out milia, even with strong pressure, and secondly, severe redness then forms in this place, which can also be quite painful. The appearance will only get worse. If you try to squeeze out milia on your own, you can introduce an infection under the skin, and scars may remain in this place or a large acne may appear. The skin around the eyes is very thin and delicate, and takes quite a long time to heal when damaged.
The peculiarity of small white dots under the eyes is that they may not go away for quite a long time, sometimes for several years. When milia are small in size they are not noticeable, but sometimes their diameter reaches a millimeter or more. Of course, this looks unaesthetic, and I want to get rid of this problem as soon as possible, especially for women.
To solve the problem, you need to contact a dermatologist who will study your skin type and decide how to remove white spots under the eyes.
Why do you need special care for skin with closed comedones?
According to the international classification of acne, the formation of comedones is the zero or initial stage of acne development.
Impaired evacuation of sebum leads to the development of a retention cyst in the gland itself, which can subsequently lead to inflammation when acne bacteria are activated.
If cleaning is performed incorrectly, for example, with excessive force, the integrity of the sebaceous gland is disrupted, leading to aseptic inflammation.
Summary: treatment for closed comedones is necessary to prevent the development of more severe forms of acne.
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How to care for skin with closed comedones
Skin care for comedones necessarily includes professional removal and accompanying home care.
The correction scheme includes 3 stages that allow you to eliminate the problem forever.
Mechanical skin cleaning
A widely known and not always popular procedure. In the case of white comedones, it is irreplaceable.
- Resorption or dissolution of closed comedones with external means is impossible. Only mechanical intervention can remove existing blockages.
- The disadvantage of this method is that the effect is temporary. New elements will appear later, because... the skin functions as before.
What should you do: constantly extract closed comedones using a needle?
No, the procedure is carried out at least once a month until the white comedones completely disappear, which is only possible with concomitant external therapy aimed at normalizing sebum production and exfoliating dead cells.
Daily skin care
The drugs of choice for closed comedones are retinoids.
Retinoids are a well-studied group of substances derived from vitamin A, used in dermatology to treat problem skin with acne, and in cosmetology to correct age-related changes and hyperpigmentation. ⠀
How retinoids work:
- They penetrate the hair follicle and exfoliate the sebaceous gland duct. Naturally influence the processes of keratinization and exfoliation of skin cells - eliminate hyperkeratosis. Thus, the outflow of the pore contents is ensured.
- They reduce the activity of sebocytes, reducing the production of sebum and reduce the density of sebum, facilitating its secretion.
- They relieve the inflammatory reaction around the gland (remove the pink halo around closed comedones), preventing further development of the process into inflamed acne.
In accordance with the Federal Clinical Guidelines for the Management of Patients with Acne, 2015, retinoids are the first-line drugs for acne correction, including the initial stages.
Benefits of Retinoids
Why else are retinoids attractive in terms of choice for eliminating white comedones:
- physiological – they are a substance familiar to the skin, because the body itself supplies vitamin A to the skin in low concentrations;
- do not have a toxic effect;
- penetrate well into the skin, reaching the necessary layers;
FAQ (frequently asked question) Can retinol be recommended in the summer?
Previously, there was an opinion that retinol should not be used in the summer. It has now been proven that retinol does not increase skin photosensitivity!
Yes, retinol thins the stratum corneum, eliminating stratum corneum, but at the same time, by stimulating cell division, it thickens the epidermis as a whole.
Summary: The sun is not a contraindication for the use of retinol.
It is recommended to use preparations containing 0.3 - 0.5% retinol, or more gentle forms. This allows you to use retinoids regularly, every evening, without getting confused in complex application regimens. And without provoking skin irritation and peeling.
Example:
Renewing cream with Retinaldehyde DermaQuest is a godsend for daily saturation of the skin with retinoids without unwanted consequences.
Benefits of the cream:
Contains a new form of retinol – retinaldehyde at a concentration of 0.05%;
The composition is enhanced with a Vitamin A simulator - Bakuchiol - increasing the effectiveness of retinaldehyde;
Contains antioxidants and moisturizing complexes - powerful prevention of inflammation and irritation of the skin, preservation of its barriers;
The difference between retinaldehyde and retinol:
- 10 times more active than retinol!
- does not cause retinoic dermatitis
- used daily
- stable to oxidation
- comfort and safety of use for sensitive skin
Application:
Apply the cream daily in the evening to clean skin.
Another type of product that is mandatory for use for closed comedones is Sunscreen with SPF based on mineral photo filters. (link to an article on the selection and use of sunscreen for oily and problem skin here .)
The sun's rays activate the sebaceous glands, which increases the number of blockages. The choice should be made in favor of physical photo filters - a mineral screen.
Chemical photo filters are contraindicated. Their operating principle is based on converting the energy of UV rays into heat, which additionally activates the work of the sebaceous glands.
Example:
Mineral cream SPF 30 with zinc DermaQuest based on micronized zinc oxide 18.6% is a universal sunscreen for all family members!
- Does not penetrate deep into the skin and does not cause blockages
- Safe and hypoallergenic
- Blocks up to 97% of sun rays
- In 2022, the composition is enriched with BlueLight filters against blue light
The advantages of modern creams with SPF are not only photoprotection, but complete care products that do not require the application of additional creams in the morning.
Prevention of milia
To prevent the appearance of milia, careful facial skin care is required using cleansers and moisturizers appropriate to the skin type, scrubs, peels, cosmetic masks that normalize the activity of the sebaceous glands; elimination of provoking factors, proper and rational nutrition, healthy lifestyle. Salon cosmetic procedures, including mechanical, ultrasonic, vacuum facial cleansing, peelings (chemical, mechanical - microdermabrasion), laser resurfacing, are quite effective in preventing the appearance of milia.
Diagnostic methods
To make an accurate diagnosis, you must seek advice from a specialist who will carry out primary diagnostic measures:
- Studies and case histories. This allows us to determine the etiological factor that can provoke the development of pathology.
- Collecting the patient's medical history. This diagnostic method makes it possible to establish the fact of the appearance of milia for physiological reasons.
- A thorough examination of the acne localization area.
- Patient interview. This allows the specialist to draw up a detailed symptomatic picture.
White acne is accompanied by the development of a certain clinical picture, so making an accurate diagnosis is not difficult. When cutting the walls of cystic formations, it is possible to easily remove the nucleus and conduct a histological examination of the contents
Characteristic symptoms
Dermatologists call milium a retention or follicular cyst that occurs after a pore is blocked by horny masses. The wall of the white acne formation is represented by the epidermis with preservation of all layers. The contents of the cyst are horny masses of dense consistency, which contain fats.
Milia are dense nodular formations that protrude slightly above the surface of the epidermis. The size of acne formations is several millimeters, and their main location is the area around the eyes.
Milia are characterized by the appearance of a certain clinical picture:
- formations appear slowly and do not cause discomfort;
- localized in the form of individual rashes, but sometimes appear in groups;
- the rashes do not form a single large spot;
- milia are milky or yellowish in color;
- the size of the formations is only a few millimeters;
- the rashes have precise outlines and protrude slightly above the epidermis;
- the course of the pathology is not accompanied by an inflammatory process;
- The size of the rash in the eyelid area remains for a long time.
Whiteheads can remain on the epidermis for many years without causing any discomfort. Sometimes milia can open up on their own and disappear without special treatment. In a situation where pathogenic microorganisms enter the acne, they become severely inflamed and suppurate.
Contraindications
It is not recommended to treat white spots around the eyes for the following conditions and diseases:
- reduced ability to regenerate tissue, which often appears with autoimmune diseases, rheumatoid arthritis;
- HIV, hepatitis C;
- acute viral or infectious condition of the whole body, as well as skin surfaces on which it is necessary to remove the wen;
- increased sensitivity to the chosen method, for example, electrocoagulation;
- increased irritability, acute allergic reactions in the area of white spots.
Procedures cannot be performed for the above diseases and conditions; the patient’s well-being will worsen.
