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Nearly 32 million Americans have eczema, with the most common type being atopic dermatitis. The condition can cause patches of dry, scaly, and extremely itchy skin—and for some people, treating it can come with another skin concern: milia.
Milia are tiny, hard, keratin-filled bumps that are white, yellow, or skin-colored and tend to pop up around the eyes and on the cheeks. There are a few different types, but people with inflammatory skin conditions like eczema can experience what’s known as secondary, or traumatic, milia, says Dara Spearman, MD, a board-certified dermatologist in Fort Wayne, Indiana. For these folks milia develop when the chronic inflammation associated with their condition weakens the skin barrier and affects the way it sheds dead skin cells, causing keratin to become trapped beneath the surface. Long-term use of strong topical steroids to treat eczema can also impact skin-cell turnover and lead to thinner skin, fueling the issue, says Dr. Spearman. “Thinner skin can be more prone to keratin becoming trapped under the surface, causing secondary milium,” she notes. Occlusive ingredients like petroleum jelly and shea butter—often used to soothe the dryness brought on by atopic dermatitis—are yet another potential contributor to milia formation when applied in excess or on areas prone to these bumps.
This can make treating eczema and milia at the same time a tricky balancing act—especially for aging people with darker skin tones, Dr. Spearman says. “As we age our skin loses moisture, and melanin-rich skin often has lower levels of lipids called ceramides, so this group tends to moisturize more. But when you use heavy oils or creams on the skin, you can form milia.”
So if you’re dealing with milia and eczema simultaneously, what should you do? Below are doctor-approved tips for treating both conditions at the same time.
Meet the experts:
- Christina Lee Chung, MD, is a board-certified dermatologist in Philadelphia.
- Dara Spearman, MD, is a board-certified dermatologist in Fort Wayne, Indiana.
Keeping eczema flares at bay
The first step in your journey to clearing up your skin should be to get your eczema under control. Preventing eczema flares allows your skin barrier to stabilize and creates the best environment for secondary milia to clear up.
Medication can be a huge help, but if you’re also experiencing milia, ask your dermatologist to re-evaluate your treatment routine. If you’re currently prescribed a topical steroid, for example, your provider may be able to switch you to a milder option. Depending on the severity of your condition, a less potent formula can still be strong enough to decrease the inflammation fueling your eczema, especially when paired with other lifestyle changes, says Dr. Spearman, adding that “there are also some newer nonsteroidal anti-inflammatory creams that can treat the eczema without thinning the skin or causing milia.”
Tweaks to your routine, like using a humidifier during the drier months and limiting time in the shower, are also helpful, since dry air and long, hot showers can suck moisture out of your skin and make eczema worse, she notes.
Christina Lee Chung, MD, a board-certified dermatologist in Philadelphia, agrees that preserving moisture is vital. “Shower for five minutes or less—just jump in and jump out,” she advises. She also stresses to her patients that it’s better for their skin’s moisture levels to stick with lukewarm water and shower just once a day or even every other day, if possible.
What you use to suds up matters too. “I always tell patients that if you want to use an antibacterial soap in hot spots like the groin or armpits, that’s fine. But on the rest of your body, use a non-antibacterial cleanser so you don’t strip extra moisture,” says Dr. Spearman, noting that she particularly likes Dove body wash. The brand’s Soothing Relief wash is formulated with colloidal oatmeal, which moisturizes and helps soothe itching. Plus, the product carries the National Eczema Association’s Seal of Acceptance, so you can feel confident it won’t aggravate your skin.
After your shower, Dr. Chung suggests patting your skin dry and applying moisturizer as soon as you towel off while it’s still moist. Dr. Spearman recommends CeraVe’s Moisturizing Cream or Cetaphil’s Moisturizing Cream, both of which are also endorsed by the National Eczema Association.
If you need something a bit heavier that’s formulated with ingredients like petroleum jelly or shea butter to soothe particularly rough spots of skin, Dr. Spearman tells her patients to use them in moderation: Avoid using these products in areas where milia tends to pop up, and instead think of them as spot treatment for stubborn eczema patches. Dr. Chung likes Aquaphor’s Moisturizing Cream, another product that gets the stamp of approval from the National Eczema Association.
Treating the milia
In terms of addressing the milia more head-on, there are a few things you can do. A dermatologist can manually extract the bumps using a sterile needle or scalpel, though this carries a possibility of scarring. Milia can also be treated with retinoids. This group of chemical compounds derived from vitamin A exfoliates the skin and increases skin-cell turnover, making dead skin cells less likely to get trapped and cause milia, says Dr. Spearman, who notes she recommends patients with eczema start with milder over-the-counter options. “The caveat is that these milder formulations do take longer to [lead to] improvement, but it helps people stick to the routine when they are so well-tolerated.” (Cocokind Advanced Retinol Gel is a National Eczema Association–approved product that may be worth trying. Dr. Spearman notes she is a fan of Olay’s new Regenerist Retinol 24 Starter Lotion, which doesn’t carry the seal.)
Since retinoids can cause dryness and further exacerbate eczema, consider applying a light moisturizer before or after the retinoid to help your skin tolerate the product. Some providers suggest using the sandwich method, which involves applying moisturizer both before and after retinoid use; if you want to give it a try, wait 10 minutes between applying each product to preserve efficacy, Dr. Spearman notes. While it will make your skin care routine a bit longer, don’t skip this important step. Beyond possibly triggering eczema flares, retinoid-related dryness and inflammation can lead to pigmentary issues, especially for folks with darker skin tones. “People of color have a lot of melanocytes [the cells that make melanin]. When they have skin irritation, the melanocytes get irritated, too, and they do one of two things: They make more melanin, or they drop pigment, so you end up getting patches of lighter or darker skin,” explains Dr. Chung.
The bottom line? You don’t have to choose between calming your eczema and keeping milia at bay. With a few tweaks to your skin care routine, a bit of trial and error—and guidance from your dermatologist—you can find a strategy that can help clear up both skin concerns.
Additional reporting by Dana Leigh Smith
