Milia, and KP, and burns...oh my! What's Up with Those Bumps?

Ok, I know we were on schedule to talk about serums and elixirs today - and then someone asked me about milia bumps. These little bits of keratin deserve some attention here because they are confusing and concerning if you've never had them and all of a sudden you do.

This was originally posted on our interim blog at catspawfarmblog.com on 10/15/2021

What are Milia bumps?

Milia are small dome shaped bumps of keratin. They can occur in all ethnicities, genders, and ages of people. The majority of the time they are not painful, though they can make up for that in annoyance factor. Sometimes friction from rough clothing or bedding can cause them to appear red and irritated. 

The bump itself is made of an excess of keratin that has accumulated under the skin's epidermis. In a nutshell they are an accumulation of dead skin cells that did not get sloughed off (naturally or mechanically) and then became engulfed and grown over by lower layers of skin due to a variety of factors (keep reading!) This creates a little pocket of cells which can feel rough and scaly if the epidermal layer is thin, or smooth and like rash bumps if the epidermal layer is thicker. Most are very tiny, being more of a tactile sensation of unevenness than a visual one.

Types of Milia

There are 2 types of milia: 

1) Primary milia: the trapped keratin described above, and 

2) Secondary milia: these look like primary milia and they develop after a duct in the skin becomes clogged after injury (burns being the most likely source of said injury). 

Keratosis pilaris (KP) is similar in appearance to milia but is the result of keratin building up around hair inside the hair follicle. It can be responsible for the condition commonly known as ingrown hair.

It's worth mentioning too that Milia have nothing to do with acne, and are not part of the immune response - they really are just skin cells temporarily in the wrong place. Causes for how they got there are varied though a lot of reasons consist of environmental damage:

• blistering injuries and skin diseases (poison ivy/poison oak/porphyria cutanea tarda/herpes)
• burns (sun/chemical/heat)
• long term use of steroid containing creams 
• using comedogenic (skin clogging) creams & oils on very thin skin
• skin resurfacing procedures such as dermabrasion or laser resurfacing
• lifestyle (lack of sleep/smoking/poor hygiene)
• aging.

***Please keep in mind that we are chatting about adult milia. There are a lot of scare-tactic articles on juvenile milia and different causes for juvenile types of milia that will probably freak you out a good deal if you're a parent looking at milia on your child. Remember not to chase zebras - most milia (adult and juvenile) have nothing to do with basal carcinomas, or lupus and the majority are going to have a fairly short and transitory span of time that they exist. If you are really concerned about your milia then see your actual doctor because self-diagnosing with Dr. Google needs to stop.*** 

The exception to milia being fairly short-term and transitory in nature are those milia that are caused by liquid paraffins/petroleum derivatives (mineral oil is one) or those milia that are caused by self-induced chemical burns. There is a LOT of lotion that has petroleum products in their formulation. Read your labels!! Additionally, some people love hot wax treatments for their hands as part of a manicure, or warm oil massage candles. My advise is to use an organic massage candle which does not contain any paraffin ingredients and which are applied at a temperature not more than 10 degrees above body temp. Your skin will thank you.

Tip: The FDA does not require candles to have ingredients listed, even if they're going on your skin. Any reputable maker can and should provide this information up front, and definitely not hedge if you ask them what their candles are made of. Our ingredients are disclosed and they are paraffin free and made of oils and butters that are good for your skin, too.

I'm going to step aside for just a moment to talking about self-induced first, second, and third degree chemical burns of the face. Some people do them quite frequently and think they are minimizing the chance for milia (or even treating them) when just the opposite is happening. Self-induced first, second, and third degree chemical burns of the face, aka Chemical Peels, aka Radiance Masks, aka Resurfacing products, etc., are an invasive method of removing complete layers of skin. Peels are designated light, medium, and deep so that you can order how much of your skin you wish to destroy at one time just like you were designating which size coffee you want this morning.

Light chemical peels remove the epidermis and cause reddening and peeling lasting for about a week. This peel can be performed by an aesthetician. It is "recommended" to burn the epidermis off once a month for best results. Cost is about $250 each time. Remember from our previous chat that the epidermis renews itself in 30 days, so following this timeline an individual would be continually burning off their newly formed epidermis each month. Remember that that tight feeling is not healthy skin, it's damaged skin. The individual would be better off (have healthier skin) with a penetrating humectant, and a sugar scrub a couple times a week.

Medium chemical peels (see photo below) must be done in a medical office with doctor supervision. The entire epidermis, the papillary region of the dermis and half of the reticular region of the dermis are removed. Recovery usually takes several weeks and there is active shedding of skin bits for about 7 days. Burning the skin in this manner costs about $2K and it is recommended to wait a year before returning for another round.

Deep chemical peels are performed in a surgical setting with the patient under general anesthesia (completely "out".) Only a physician can perform a deep chemical peel. There are serious side affects such as permanent skin discoloration (bleached look and a definite line of demarcation) as well as dangerous heart arrhythmias that can occur during this procedure. The epidermis, dermis, and most of the subdermal tissue are removed and the skin oozes and scabs. This is an induced third degree chemical burn leaving only a few cell layers of skin behind. In some cases scabbing and scarring will involve the underlying muscle tissue as well. Healing continues well into three months post-surgery and it is recommended (by practitioners) to never have a second procedure of this sort in one's lifetime. Deep peeling will run about $6K.

If you think I'm being overly critical or dramatic search on Google for "chemical peel gone wrong", and click over to the Images tab. There are many people waiting to share their personal cautionary tales with you.

Ok, back to milia....aging poses some unique problems as it is out of our control for the most part. The majority of people I've spoken with who underwent the above type of burning peels have shared with me that the results did not rewind their clock to the degree they expected once the skin healed and most agreed that their skin never behaved "normally" afterwards either. There are some things we can do about milia though and that's what we're going to spend the rest of our time chatting about.

It's important to not address milia or KP in an aggressive manner. It might sound like grabbing a loofah and scrubbing away is a great idea, but that can trigger skin to make even more of the protein that's causing the milia in the first place. My personal method of handling milia is a steamy shower to get the skin as receptive as possible, then a brown sugar scrub (see my previous Blog Post ) Remember that sugar naturally contains a small amount of glycolic acid and can help your skin attain a gently exfoliated state. Moisturizing with lotion is also going to be your friend when it comes to getting rid of your keratin bumps.

Most of the time milia will go away on its own, even without brown sugar scrub and lotion, but those couple of months can seem like an eternity. There are physician office treatments such as cryotherapy (freezing with liquid nitrogen), deroofing (picking the keratin out with a sterile needle), laser ablation, diathermy (destroying the keratin and surrounding cells with extreme heat), electrodessication (burning through the epidermis to torch the keratin with electricity), and destruction curettage (surgical scraping and cauterizing with heat). Each individual will have a different view on these procedures and thus value their effectiveness after weighing the process vs the outcome and effect on one's skin.

Thorough cleansing and removing makeup before bed is the number one step cited as ways to preventing milia from forming again. That brown sugar facial scrub as a manual exfoliant is also very important to keep skin cell build up at bay. Choose an eye product that penetrates effectively, avoid comedogenic oil bases, and limit sun exposure to give your skin a preventative boost, too.

I hope you are enjoying this series on skin and the products effective in its care. Next week we'll do our dive into toners, serums, and elixirs. Thanks for hanging out with me!