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Ask Kerry: Whiteheads v. Milia

Hi Kerry-
I don’t really get the difference between whiteheads and milia. Can you help?

Skin bumps can be pretty challenging to diagnose yourself, especially because they look slightly different from person to person. Whiteheads are a type of acne, so if you’ve ever had a blemish-prone phase (and who hasn’t!), you’ve probably had a whitehead. Whether you’ve had milia depends largely on genetics. Read on for a few tips for telling the difference!

Whiteheads

What it is: A whitehead, also known as a closed comedone, is a type of acne that most breakout-prone people experience regularly. Whiteheads occur when excessive sebum mingles with dead skin cells and debris, resulting in a clog below the skin.

What it looks like: Unlike blackheads, which are open to the air, whiteheads are closed by a thin layer of skin, giving them a raised, white appearance. Whiteheads are usually smaller and less painful than other types of acne like cysts or nodules; however, they may be slightly tender to the touch.

How to be sure: Whiteheads are most common on the forehead and chin—areas that produce a lot of oil. A whitehead will be mostly skin-colored with a white center and some redness around the edges.

How to treat it: Acne treatments containing salicylic acid, retinol, or glycolic acid can help treat and prevent whiteheads. I never recommend picking, but if you have a whitehead that looks ready to burst, you can gently apply a warm compress until the pore naturally purges the clog. If nothing happens, leave it alone and seek help from a pro who can safely extract clogs without damaging your skin.

Milia:

What it is: Milia occurs when keratin becomes trapped at the base of a follicle, forming a tiny, painless bump. Milia can be caused by using heavy creams, but usually genetics are to blame.

What it looks like: A very tiny, usually very white bump—about the size of a large grain of sand. The area around the bump likely won’t be raised or inflamed at all. When you gently run your finger over milia, it will almost feel like there is a small pebble right under your skin.

How to be sure: Milia generally occur around the eye, eyelids, and upper cheeks. It is unusual to get milia on the forehead and chin, where whiteheads are common. Milia will not respond to hot compresses, pinching, or prodding.

How to treat it: Don’t squeeze it! Milia is trapped under the skin, and can’t be extracted through the pore. Milia often clears up on its own, but you can speed up the process by exfoliating regularly with a peel or dermaplaning tool. As you slough off dead cells and the skin regenerates, the keratin will come to the surface and can be extracted. Need milia gone now? A dermatologist can help. They will use a tiny needle to poke a hole in the skin and then gently pull the keratin plug out. Don’t try this yourself!

Want help with other skin concerns? Pop your burning questions in the comments and I’ll answer them on the blog!

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