Bumps around the eyes

What Are The Skin Colored Bumps Under My Eyes? 5 Things You Didn’t Know About Milia

When bumps pop up on your skin, it’s natural to be a little nervous. Trying new beauty products can lead to skin reactions, which are usually relatively harmless. But you’ve probably stumbled upon some little dots near your nose and wondered, “What are the skin colored bumps under my eyes?” One of the most common skin problems known to man is called milia, and yes, they are the little white or flesh-colored dots that appear on your skin, usually under your eyes. “Milia, or keratin ‘pearls’ are tiny collections of keratin under the skin,” dermatologist Dr. Deanne Mraz Robinson, MD, FAAD explains.

Luckily milia are common, painless, and “totally harmless, just cosmetically annoying,” dermatologist Dr. Jessica Krant, MD, MPH tells Bustle. The most typical place for them to pop up is on the face, usually on the skin around your eyes or on your cheeks. However, they can appear pretty much anywhere, and “can come in any age group at really any time,” dermatologist Dr. Dhaval G. Bhanusali, MD, says. “They are commonly seen in babies but we also see milia in the office almost daily.” Left untreated, milia may go away on their own, but they don’t always. As with all skin concerns, it’s best to see a board-certified dermatologist to get a proper diagnosis and treatment plan, if treatment is necessary. To hold you over until that appointment, here are five things you may not already know about milia.

1. Milia are not acne.

Yes, they’re similarly annoying bumps, but milia are not a form of acne. “Milia, or milium cysts, are very tiny true cysts made up of a sac or shell of outer layer skin cells known as keratinocytes,” Krant explains. “They sit immediately under the top layer of skin and show as small, hard, white bumps … Milia are not the same as pimples or whiteheads. For this reason, most aestheticians, upon encountering true milia, will refer to a board-certified dermatologist for removal.” Again, there’s no medical need to remove them, but if they’re bothering you for an aesthetic reason, a dermatologist can help you out.

2. Your beauty routine could be to blame.

Krant, Mraz Robinson, and Bhanusali all mention that certain skin care products could trigger milia. Specifically, Mraz Robinson says “very occlusive, oily, or heavy skin care products” could be the culprit. Bhanusali also notes, “We commonly see it in our entertainment crowd due to production makeup being so heavy and a lack of cleansing after.”

3. But derms aren’t always sure what causes them.

In addition to heavy skin care products, Krant notes that milia can form after a skin injury. “But sometimes they form and dermatologists don’t really know why,” she says. In addition, Krant says that we don’t yet know if genetics can play a role in your likelihood of developing milia, although Bhanusali notes they are very rarely associated with Rombo syndrome and Gardner syndrome.

4. You shouldn’t try to remove them at home.

Since heavier products could trigger milia, switching up your skin care routine might help slowly reduce the number of milia that form on your face. “I usually tell my patients to try a gentle alpha (glycolic) or beta (salicylic) acid cleanser for a week or two. Sometimes, if the milia are very superficial, it can push the debris out,” Bhanusali says. However, you should never try to remove the individual milia at home. “True milia can not be removed at home. Trying to remove them with a comedone extractor at home will cause injury and possibly scarring and infection,” Krant explains. “Removing them requires a small surgical procedure that even aestheticians are not allowed to perform because it requires truly going beneath the skin surface.” Since removing them does require breaking the skin surface, Mraz Robinson notes the process “can carry the risk of infection or damage to the skin” if not done in a dermatologist’s office.

5. Removal by your doctor is not usually covered by insurance.

Since there is no medical reason to get rid of milia, you’ll likely have to pay out of pocket if you want them removed. “Dermatologists can help remove any milia, but keep in mind this procedure is considered cosmetic by insurance companies, and is therefore generally not covered by insurance,” Krant explains. Since they’re totally normal and have no medical risk, it might be easier to just work on embracing those little bumps instead.

This post was originally published June 19, 2015. It was updated July 8, 2019.

Bumpy Growths Around the Eyes

One of those possibilities would be injury to the underlying tendon and the formation of a cyst that is actually connected to the tendon. Injuries to the tendon may result in long-term loss of function so early identification and treatment is important. Orthopedic surgeons and plastic surgeons most commonly deal with problems such as yours, and I would recommend you obtain a consultation.

Q3. I get red, dry bumps on the tops of my arms. I think it’s dry skin. What can I do?

— Lena, Ohio

Red, rough bumps on the top of the arms are most likely due to a common condition called keratosis pilaris. In certain individuals, the skin overproduces the protein keratin, which makes up your hair and outer layer of skin. Tiny plugs of keratin (bits of dead skin) can clog the hair follicles, producing small bumps resembling “chicken skin.” These can range from a few dry bumps to large, rough patches of skin. The most commonly affected areas include the tops of the forearms and thighs, the back of the upper arms, the sides of the hips, and the cheeks.

Although we don’t know exactly why keratosis pilaris occurs, it does seem to have a hereditary component. It often runs in families, and it can be associated with atopic dermatitis (eczema), asthma, and seasonal allergies (hay fever). It usually looks and feels worse in the winter, when skin becomes drier and there’s less humidity in the air.

The following tips can help minimize the appearance of keratosis pilaris:

  • Because dry skin aggravates the condition, keep your skin well-moisturized. Look for a body lotion that contains lactic acid to help soften and smooth rough bumps. The best time to apply this lotion is right after you get out of the shower or bath. Pat dry with a towel, and apply lotion liberally to lock in moisture. Try AmLactin or Lac-Hydrin Five, available at most drugstores.
  • While you can’t scrub off the bumps, it is a good idea to gently exfoliate with a washcloth, loofah, or body scrub once or twice a week — but no more than that — to help loosen the plugs and remove dead skin. Look for scrubs that contain smooth beads that won’t irritate your skin. Avoid scrubs made with walnut shells, apricot seeds, or salt, all of which can scratch your skin and make the bumps more angry-looking.
  • Resist the urge to pick, squeeze, or overscrub your skin. Picking the bumps will make them scab, which can leave dark marks and possibly permanent scars.
  • For stubborn cases, see your dermatologist, who might recommend prescription-strength topical medications (such as urea or Retin-A) or a mild chemical peel to help unclog the follicles.

Q4. I’m a 39-year-old woman with a new skin problem. When the weather started getting warm, I began breaking out in little red bumps across my chest, forearms, and hands. I’ve been on the birth control patch for about five months, and I’ve heard it can cause a rash. Is there a connection, or could it be some kind of sun allergy?

Oral contraceptives and patch-delivery birth control that contain estrogens and progestin have been implicated in some sun reactions, but rarely in sun allergies. A sun allergy usually shows up as a rash on sun-exposed skin, typically the chest and arms. Birth control pills and contraceptive patches commonly result in pigmentary changes — for example, a tannish discoloration of the face after sun exposure.

In determining the nature of a “sun allergy,” it is important to review one’s medications, including prescription and over-the-counter drugs, as well as vitamin and mineral supplements. Certain drugs are known to be photosensitizers — while you’re taking them you can develop a “sun rash” if you spend too much time in the sun. You also need to rule out systemic reasons for the rash, such as any underlying diseases that may induce a sun reaction.

If you are healthy and on no medications, you may have what is known as PMLE (polymorphous light eruption) — itchy red bumps that develop after the first exposure to sun each spring or summer. You may experience the rash during a holiday to a sunny climate where you spend more time in the sun. Usually the reaction will clear within a week’s time. Oral antihistamines and topical emollients with cortisone may offer relief.

Usually, applying a broad-spectrum sunscreen with UVA and UVB coverage, as well as avoiding too much exposure and wearing adequate clothing to cover up while in the sun, is all that’s required for the majority of patients. However, more aggressive measures may be taken by your dermatologist after further diagnostic workup.

Learn more in the Everyday Health Skin and Beauty Center.

Those hard, white bumps under your skin that just won’t let up, no matter how hard you squeeze?

They probably aren’t spots.

Often tiny but always annoying, milia can crop up anywhere under the skin, although most of us tend to mistake them for acne clusters or even skin tags.

The good news? There are so many simple ways to stop milia from rearing their heads and some seriously effective methods for milia removal if you’re late to the game.

Smooth, flawless skin, here we come.

Rosdiana Ciaravolo

What Are Milia?

Before you undergo some major milia removal, it pays to know exactly what they are.

Spoiler: Even though they may look similar to whiteheads, they are nothing like them.

‘Milia are small white bumps or cysts that appear on the surface of the skin when dead skin cells become trapped,’ explains Consultant Dermatologist Dr. Anjali Mahto.

‘They are made up of keratin, a protein on the outer layer of the skin, and whilst they resemble whiteheads, they are not related to acne or infection and are simply a pocket of normal skin. They shouldn’t be treated in the same way,’ she adds.

Getty Images

What Causes Milia?

According to Dr. Anjali, milia on the face are usually formed spontaneously, and there are a number of factors that contribute.

‘Milia found around the eye area can be caused by heavy creams, where the skin around the eye is much thinner than other areas of the face,’ adds Dr. Anjali.

But they can also crop up elsewhere.

‘Milia can also occur on the nose and other areas of the body,’ she says. ‘They tend to occur as a result of skin damage – predominantly sun damage – as well as rashes and excessive use of harsh products on the skin.’

How Do I Get Rid Of Milia?

Dealing with milia might feel like a never ending battle, especially as you can’t satisfyingly squeeze them like spots.

Here’s how to get rid of milia for good:

Imaxtree

1. Gentle Exfoliation

There are endless benefits to exfoliating your skin, including: minimising hyper-pigmentation, banishing blemishes and reducing superficial acne scarring – and seeing as milia are a result of trapped skin cells, exfoliation is brilliant at keeping them from springing up, too.

‘ allows the dead skin cells to be removed, resulting in much less build up,’ explains Dr. Anjali.

‘It also allows for moisturiser to penetrate the skin further,’ she adds, which means you’ll get a hell of a lot more out of your luxury skincare arsenal.

Matteo Scarpellini

2. Chemical Peels

Superficial peels containing AHAs and BHAs, including glycolic and salicylic acid, provide accelerated, chemical exfoliation without the need to aggressively scrub your skin.

Non-abrasive, they only lift off the top layer of skin, ensuring the skin is ‘clean and fresh,’ according to Dr. Anjali. And fewer dead cells = fewer unsightly bumps.

Can’t make it to a professional clinic? At-home face peels are gaining traction among those on a quest for clearer, more refined skin, and with high concentrations of exfoliating ingredients like lactic and glycolic acid, the de-congesting, complexion perfecting results are pretty much undeniable.

The best part? There’s zero downtime.

ELLE Edit: At-Home Face Peels

Glycol Lactic Radiance Renewal Mask REN CLEAN SKINCARE cultbeauty.co.uk £36.00

If congested and sun-damaged skin is getting you down, then REN’s Glycolic acid mask is the one for you. Formulated with 5-6.5% Glycolic acid, it’ll slough away dead skin cells minus the irritation – which means it’s ideal for even sensitive skin types.

Resurfacing Mask Tata Harper cultbeauty.co.uk £57.00

Amazing for beginners, Tata Harper’s natural BHA resurfacing mask is the ultimate glow-giver. Supercharged with White Willow Extract, it sloughs away dull surface cells to uncover an impressive radiance so you can skip the Insta-filter altogether.

It’s also formulated with Beet Extract which ups hydration levels to give the effect of perkier, bouncier skin, and packed with aloe vera to soothe and repair.

Peel & Polish Pixi cultbeauty.co.uk £26.00

Pixi’s 5-minute mask doesn’t just sit there. A dream team of lactic acid and enzymes work to buff over bumpy, rough patches and to chip away at the almost paste-like mixture of dead skin cells and oil that can lead to blackheads. It’ll lend your complexion an airbrushed effect – all sans the dreaded sting.

Caudalie Glycolic Peel Caudalie lookfantastic.com £17.60

This is a favourite amongst beauty editors for the way it speeds up cell turnover – and at a fraction of the price of most retinoids. It takes a mere ten minutes for the myriad of natural ingredients to work their magic when applied to dry skin.

Simply rinse off and marvel over how pillowy your skin is. Beauty Sleep Power Peel Alpha-H cultbeauty.co.uk £54.00

This turns lacklustre skin luminous, all while you catch your Zs. Added retinol works to rev up cell production and glycolic acid makes skin soft, supple and gorgeously glowy. Expect a taut, polished feel with zero sting.

Rolling Cream Peel With AHA By Mario Badescu Mario Badescu beautybay.com £18.00

Sluggish skin cells don’t stand a chance against Mario Badescu’s Rolling Cream Peel which marries lactic acid (a gentle BHA) with Peach Extract (a natural AHA). It requires you to rub it off after just one minute, but it’s the kind of product that quenches skin all day thanks to the added Vitamin E and Shea Butter.

Zelens PHA+ Bio-Peel Resurfacing Facial Pads Zelens lookfantastic.com £65.00

Drenched in four different hydroxy acids, Zelens’ quick pads blur lines, dark spots and send enlarged pores into submission. Just don’t be confused by the PHA part. These acids are really similar to AHAs but have a higher molecular structure which slows down the rate at which they penetrate the skin, making them perfect for those who have issues with sensitivity.

Time Bomb Overnight Peel And Reveal Time Bomb lookfantastic.com £42.00

Time Bomb’s peel and reveal duo will give you skin so soft you’ll want to keep touching it throughout the day. Before your head hits the pillow, simply smooth the clear, gel-like peel over a clean face until absorbed.

Don’t be alarmed by the slight stinging sensation – it passes, promise!When you wake up in the morning, dampen your face and polish away all traces of lifeless skin using the gentle dermabrasion cream, et voila.

3. Ditch Heavy Creams For Lightweight Textures

If milia tend to cluster around your eye area, it could have something to do with the texture of your skincare products. That super-luxe eye cream you just splurged on? It might be doing your skin more harm than good.

Applying thicker creams to thin and delicate areas of skin has the potential to both block the pores and to trap dead skin cells – cue an army of pesky under-the-skin bumps.

The solution? A lightweight eye cream formula that’s quickly absorbed without blocking pores.

SHOP THE BEST EYE CREAMS

4. Incorporate Retinol Into Your Night-Time Routine

Retinols (vitamin A derivatives) are brilliant at kick-starting cell turnover, and less layers of dead skin results in fewer obstructions, fewer white bumps and a more even, flawless skin texture.

And although retinol has bit of a bad rap in skincare for turning complexions flaky and red, there are gentle yet effective formulas out there.

Bumps, be gone.

SHOP THE BEST RETINOL SERUMS

IMAXTREE.COM

5. Professional Extraction

‘There are many tried and tested treatments available for the removal of milia,’explains Dr. Anjali, ‘however one of the most common is by using a sterile needle to create an incision in the skin, making way for careful extraction.’

But to avoid infection and scarring, it’s best not to attempt it at home without consulting a professional first.

‘The treatment should be undertaken by a qualified dermatologist,’ stresses Dr. Anjali. ‘They will be able to recommend the best way of extracting the milia. The best type of treatment will also depend on the type of milia you have, as well as the number and location on the face.’

Gotcha.

Rodisana CiaravoloGetty Images

6. Avoid Increased Sun Exposure

This one is a given, but according to Dr. Anjali, increased sun damage and milia go hand in hand – not cool when you’re on the hunt for flawless skin.

At the risk of sounding like a broken record, incorporating an SPF into your morning skincare routine is just as important in the winter months as it is in the summer, especially if you’re using peels or exfoliators containing acids, as they can make your skin ultra-sensitive to UV.

Hate the greasy, chalky feel most SPFs lend your skin? Shop the best facial SPFs here.

7. Book In For An Electrodessication Treatment

We know what you’re thinking: Electrodessi-what?

But if you’ve been down the exfoliation, chemical peel and retinol route to no avail, you might want step up your game and book in for a professional treatment to get rid of your milia.

‘This process uses electricity to heat the skin and to destroy the milia,’ explains Dr. Anjali – but don’t worry, it’s done under a local anaesthetic cream to minimise any twinges.

Crystal clear skin? Yes please.

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What to know about milia under the eyes

Share on PinterestMilia in babies usually clears up over time without treatment.
Image credit: Serephine, 2011

Some cases of milia clear up without any treatment within a few months. Most people who had milia on their face as an infant no longer have any.

However, this is not always the case, and there is no set standard for treatment. Although the bumps are not harmful, many people have cosmetic concerns about milia under the eyes and on the face.

People should never squeeze a milium as they would a pimple. This will irritate the skin and could damage the sensitive skin in the area.

Most at-home milia treatments involve gentle exfoliation or chemical peels. However, it is important to speak to a doctor before using these techniques, especially around the eyes. A doctor may also offer in-office removal.

Chemical peels

Sometimes, a dermatologist may recommend a chemical peel. However, it is important to remember that over-the-counter exfoliative chemicals are unlikely to get rid of milia under the eyes.

Common active ingredients in chemical peels include:

  • lactic acid
  • glycolic acid
  • salicylic acid

However, the area under the eye is very sensitive, so it is important to take extra care. Always speak to a dermatologist before using any chemical exfoliants.

Professional options

A dermatologist may be able to remove milia under the eyes using techniques in their office. These include:

Extraction

Milium extraction is a common process wherein dermatologists use a tiny needle, or scalpel, to remove part of the skin over the cyst.

Opening the pore in this way allows them to carefully manipulate the keratin out. After this, people will need to take steps toward prevention to keep the milia from coming back.

Laser ablation

During laser ablation, a dermatologist uses a tiny laser to focus on the milium itself, opening the pore.

Cryotherapy

In some cases, cryotherapy may be a worthwhile treatment method. Cryotherapy uses liquid nitrogen to freeze and destroy the milia.

However, as the skin below the eye is sensitive, this may not be the best option for milia in this area. It may be painful and cause scarring or pigmentation changes.

As we’ve learned with pimples and cold sores, certain skin ailments can prove difficult to tell apart. So often when a red bump or pus-filled pustule appears, we have a tendency to automatically assume it’s some form of acne and treat it as such — or we just wait it out and pray it goes away. But in reality, said red bump can be a multitude of things, including the aforementioned cold sore, so it’s crucial to know what you’re working with in order to properly treat it.

Take styes and milia, for instance. Both are common skin woes that, because of their blemish-like appearance, are quite often confused with pimples or another form of acne, such as whiteheads. Because of how close the three ailments are in appearance, we tapped a few trusted dermatologists for a definitive breakdown of styes, pimples, and milia — and how to effectively ward off each.

Milia

Milia (Milium) – pimples around eye on skin.Getty Images

Milia is a condition characterized by tiny, painless white bumps surrounding the eye area. They are often mistaken for whiteheads. “Milia are tiny cysts arising from sweat ducts, made of keratin and found just below the skin,” says Neil Sadick, a dermatologist and founder of Sadick Dermatology in New York City. They’re usually firm, white, and one to two milimeters in diameter, he says.

Milia are most often found on the face, occurring around the eyes and on the cheeks, according to Joshua Zeichner, the director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York City. Milia can affect people of all ages, though Sadick says milia is commonly found in newborns.

While milia can develop spontaneously or as secondary events during healing from burns, lasers, and microdermabrasion, other factors, such as genetics and the use of heavy occlusive cosmetics, may also cause spots to pop up, says Zeichner. The most common cause of milia? Sun exposure, says Adam Friedman, the residency program director at The George Washington University School of Medicine & Health Sciences in Washington, D.C. As UV radiation damages the support structures of the skin, it leaves pores wide open, which in turn, allows keratin to become trapped under the skin, resulting in the tiny white nodule.

Milia can be treated using topical retinoids similar to that of acne, however, Zeichner recommends seeing your doctor for best results. ” needs to be opened up by your dermatologist, as they usually do not go away on their own,” he says. This is done by making a small nick in the skin with a super-sharp sterile blade, and then squeezing until the inside remnants come out. (Graphic, no?)

Styes

man with a stye on his inner eye rimGetty Images

Pigmented Birthmarks can grow anywhere on the skin and at any time. They are usually black, brown, or skin-colored and appear singly or in groups. They can be moles (congenital nevi) that are present at birth; Mongolian spots, which look like bluish bruises and appear more frequently on people with dark skin; or café-au-lait spots that are flat, light brown, or tan and roughly form an oval shape.

Red Birthmarks (also known as macular stains) develop before or shortly after birth and are related to the vascular (blood vessel) system. There are a number of different types:

  • Angel kisses, which usually appear on the forehead and eyelids.
  • Stork bites, which appear on the back of the neck, between the eyebrows on the forehead, or on eyelids of newborns. They may fade away as the child grows, but often persist into adulthood.
  • Port-wine stains, which are flat deep-red or purple birthmarks made up of dilated blood capillaries (small blood vessels). They often appear on the face and are permanent.
  • Strawberry hemangiomas, composed of small, closely packed blood vessels that grow rapidly and can appear anywhere on the body. They usually disappear by age nine.
  • Cavernous hemangiomas are similar to strawberry hemangiomas but go more deeply into the layers of the skin. These can often be characterized by a bluish-purple color. They also tend to disappear naturally around school age.

Keratosis Pilaris

Also known as follicular keratosis, this is a hereditary skin disorder that causes goosebump-like lesions on the back of the arms, thighs, or buttocks. The patches of bumps tend to get dry and itchy, particularly during the winter months. Keratosis pilaris occurs at any age. Because it is hereditary, there is no method of prevention. In some cases, it goes away on its own over time; in other cases, the condition is chronic. Keratosis pilaris is not harmful, however, it is very difficult to treat.

Keratosis pilaris is caused by a build-up of keratin, a protein in the skin that protects it from infection. Keratin plugs up hair follicles causing the rough, bumpy rash. Treatment options include prescriptions for:

  • Medicated creams or lotions with 12 percent ammonium lactate that softens the affected skin.
  • Moisturizers (urea) that help loosen and remove dead skin cells.
  • Topical corticosteroids for short-term, temporary relief of symptoms.
  • Topical retinoids that increase cell turnover, which reduces the plugging of hair follicles.

To help alleviate symptoms, be sure to keep the affected area moistened at all times and avoid harsh soaps.

Lumps, Bumps, and Cysts

There are literally hundreds of different kinds of lumps, bumps, and cysts associated with the skin. Fortunately, the vast majority of these are harmless and painless. Below is a guide for some of the most common forms of skin lumps, bumps, and cysts:

Dermatofibromas

  • Red, brown or purple growth; generally benign
  • Usually found on arms and legs
  • Feels like a hard lump
  • Can be itchy, tender to the touch, and sometimes painful

Treatment

  • Usually does not require treatment
  • Most common removal by surgical excision or cryotherapy (freezing it off with liquid nitrogen)

Epidermoid Cysts (Sebaceous Cysts)

  • Round small bumps, usually white or yellow
  • Forms from blocked oil glands in the skin
  • Most commonly appear on the face, back, neck, trunk, and genitals
  • Usually benign; occasionally leads to basal or squamous cell skin cancers
  • If infected, will become red and tender
  • Can produce a thick, yellow, cheese-like discharge when squeezed
  • Antibiotics might be prescribed if there is an underlying infection
  • Dermatologist removes the discharge and the sac (capsule) that make up the walls of the cyst to prevent recurrence
  • Laser surgery may be used for sensitive areas of the skin, like the face

Characteristics

  • Red pimples around areas having hair
  • Inflammation of the hair follicles
  • Caused by infection or chemical or physical irritation (e.g., shaving, fabrics)
  • Higher incidence among people with diabetes, the obese, or those with compromised immune systems
  • Topical antibiotics
  • Oral antibiotics
  • Antifungal medications
  • Eliminating the cause

Keratoacanthoma

  • Red, dome-shaped, thick bumps with craters in the center
  • Abnormal growth of hair cells
  • Triggered by minor skin injury such as a cut or bug bite
  • Ultraviolet radiation from sun exposure is the most common risk factor
  • Cryotherapy (freezing off the bump with liquid nitrogen)
  • Curettage (surgically cutting out or scraping off)
  • Small, rough, white or red bumps that neither itch nor hurt
  • Usually worse during winter months or when there is low humidity and the skin gets dry
  • Usually does not require treatment
  • In most cases disappears on its own by age 30
  • Intensive moisturizing is the first line of treatment
  • For more difficult cases, use of medicated creams with urea or alpha-hydroxy acids
  • Soft, fatty tissue tumors or nodules below the skin’s surface
  • Usually slow growing and benign
  • Appear most commonly on the trunk, shoulders, and neck
  • May be single or multiple
  • Usually painless unless putting pressure on a nerve
  • Usually does not require treatment unless it is compressing on the surrounding tissue
  • Easy to remove via excision
  • Soft fleshy growths under the skin
  • Slow growing and generally benign and painless
  • Pain may indicate a need for medical attention
  • May experience an electrical shock at the touch
  • Usually does not require treatment, particularly if it does not cause any symptoms
  • If it affects a nerve, it may be removed surgically
  • Closed pockets of tissue that can be filled with fluid or pus
  • Can appear anywhere on the skin
  • Smooth to the touch; feels like a pea underneath the surface
  • Slow growing and generally painless and benign
  • Only needs attention if it becomes infected or inflamed
  • Usually does not require treatment; often disappears on its own
  • May need to be drained by a physician
  • Inflamed cysts respond to an injection of cortisone, which causes it to shrivel

Moles (Nevi)

Moles are brown or black growths, usually round or oval, that can appear anywhere on the skin. They can be rough or smooth, flat or raised, single or in multiples. They occur when cells that are responsible for skin pigmentation, known as melanocytes, grow in clusters instead of being spread out across the skin. Generally, moles are less than one-quarter inch in size. Most moles appear by the age of 20, although some moles may appear later in life. Most adults have between 10 and 40 moles. Because they last about 50 years, moles may disappear by themselves over time.

Most moles are harmless, but a change in size, shape, color, or texture could be indicative of a cancerous growth. Moles that have a higher-than-average chance of becoming cancerous include:

Congenital Nevi

Moles present at birth. The larger their size, the greater the risk for developing into a skin cancer.

Atypical Dysplastic Nevi

Irregularly shaped moles that are larger than average. They often appear to have dark brown centers with light, uneven borders.

Higher frequency of moles

People with 50 or more moles are at a greater risk for developing a skin cancer.

In some cases, abnormal moles may become painful, itchy, scaly, or bleed. It’s important to keep an eye on your moles so that you can catch any changes early. We recommend doing a visual check of your body monthly, including all areas that don’t have sun exposure (such as the scalp, armpits, or bottoms of feet).

Use the American Academy of Dermatology’s ABCDEs as a guide for assessing whether or not a mole may be becoming cancerous:

  • Asymmetry: Half the mole does not match the other half in size, shape, or color.
  • Border: The edges of moles are irregular, scalloped, or poorly defined.
  • Color: The mole is not the same color throughout.
  • Diameter: The mole is usually greater than 6 millimeters when diagnosed, but may also be smaller.
  • Evolving: A mole or skin lesion that is different from the rest, or changes in size, shape, or color.

If any of these conditions occur, please make an appointment to see one of our dermatologists right away. The doctor may do a biopsy of the mole to determine if it is or isn’t cancerous and/or may surgically remove it.

Molluscum Contagiosum

Molluscum contagiosum is a common skin disease caused by a virus. This virus easily spreads from person to person. People can get molluscum by sharing towels and clothing. Skin-to-skin contact also spreads the virus. Whenever you can see the bumps on the skin, molluscum contagiosum is contagious.

Often the only sign of molluscum is pink or flesh-colored bumps on the skin. These bumps can appear anywhere on the skin. Most people get about 10 to 20 bumps on their skin. If a person has a weakened immune system, many bumps often appear. People who have AIDS can have 100 or more bumps.

A dermatologist often can diagnose molluscum contagiosum by looking at the skin. Your dermatologist may refer to the bumps on the skin as mollusca. Sometimes the mollusca look like another skin condition. They can look like warts, chickenpox, and even skin cancer. If this happens, your dermatologist will scrape off a bit of infected skin. The infected skin will be examined under a microscope. After diagnosis, treatment helps to prevent the virus from:

  • Spreading to other parts of your body.
  • Spreading to other people.
  • Growing out of control in people who have a weakened immune system.

There are many treatment options. The treatment your dermatologist prescribes will depend on your age, health, where the bumps appear on your body, and other considerations. Treatments may include:

  • Cryosurgery: The dermatologist freezes the bumps with liquid nitrogen.
  • Curettage: The dermatologist may use a small tool called a curette to scrape the bumps from the skin.
  • Laser surgery: A dermatologist uses a laser to target and destroy the bumps. This can be an effective treatment for people who have a weakened immune system.
  • Topical (applied to the skin) therapy: Your dermatologist can apply various acids and blistering solutions to destroy the bumps. These work by destroying the top layers of the skin. Tricholoracetic acid is often used to treat people who have a weak immune system and many bumps.When a patient has many bumps or large bumps, a dermatologist may need to repeat the procedure every 3 to 6 weeks until the bumps disappear. These procedures cause some discomfort. While treating the bumps, it is normal for new bumps to appear as others fade.

Seborrheic Keratosis

Also known as seborrheic verruca, most people will develop at least one seborrheic keratosis during a lifetime. Fortunately, these lesions are benign and don’t become cancerous. They are characterized as brown, black, or yellow growths that grow singly or in groups and are flat or slightly elevated. Often they are mistaken for warts. Generally, no treatment is required unless the growth becomes irritated from chafing against clothing. However, because it look similar in appearance to precancerous growths (actinic keratosis), your dermatologist will likely biopsy the tissue to confirm the diagnosis.

If a seborrheic keratosis becomes irritated or unsightly, removal is conducted using one of these three methods:

  • Cryosurgery: Freezes off the growth using liquid nitrogen.
  • Curettage: Doctor scrapes the growth off the surface of the skin.
  • Electrocautery: Used alone or in conjunction with curettage to burn off the tissue and stop the bleeding.

Warts

Warts are small, harmless growths that appear most frequently on the hands and feet. Sometimes they look flat and smooth, other times they have a dome-shaped or cauliflower-like appearance. Warts can be surrounded by skin that is either lighter or darker. Warts are caused by different forms of Human Papilloma Virus (HPV). They occur in people of all ages and can spread from person to person and from one part of the body to another. Warts are benign (noncancerous) and generally painless. They may disappear without any treatment. However, in most cases eliminating warts takes time.

The location of a wart often characterizes its type:

Common warts can appear anywhere on the body, although they most often appear on the back of fingers, toes, and knees. These skin-colored, dome-shaped lesions usually grow where the skin has been broken, such as a scratch or bug bite. They can range in size from a pinhead to 10mm and may appear singly or in multiples.

Filiform warts look like a long, narrow, flesh-colored stalk that appears singly or in multiples around the eyelids, face, neck, or lips. They are sometimes called facial warts. They may cause itching or bleeding, but are easy to treat with over-the-counter medications.

Flat (plane) warts appear on the face and forehead. They are flesh-colored or white, with a slightly raised, flat surface and they usually appear in multiples. Flat warts are more common among children and teens than adults.

Genital warts appear around the genital and pubic areas. It is also possible to get genital warts inside the vagina and anal canal or in the mouth (known as oral warts). The lesions start small and soft but can become quite large. They often grow in clusters. They are both sexually transmitted and highly contagious. In fact, it is recommended you generally avoid sex with anyone who has a visible genital wart. Genital warts should always be treated by a physician.

Plantar warts appear on the soles of the feet and can be painful since they are on weight-bearing surfaces. They have a rough, cauliflower-like appearance and may have a small black speck in them. They often appear in multiples and may combine into a larger wart called a mosaic wart. Plantar warts can spread rapidly.

Subungual and periungual warts appear as rough growths around the fingernails and/or toenails. They start as nearly undetectable, pin-sized lesions and grow to pea-sized with rough, irregular bumps with uneven borders. Subungual and periungual warts can impede healthy nail growth. Because of their location, they are difficult to treat and generally require medical attention.

Most warts respond to over-the-counter treatments, including:

  • Cryotherapy, which freezes off the wart using liquid nitrogen or nitrous oxide.
  • Electrosurgery, which sends an electric current through the wart to kill the tissue.
  • Laser surgery, which essentially heats up the wart until the tissue dies and the wart eventually falls off.
  • Nonprescription freezing products (dimethyl ether), aerosol sprays that freeze the warts and cause them to die off.
  • Salicylic acid preparations, which dissolve the protein (keratin) that makes up the wart and the thick layer of skin that covers it. It comes in gels, pads, drops, and plasters and takes 4 to 6 weeks to eradicate the warts.

If self-treatments don’t work after a period of about 4 to 12 weeks, contact our dermatologist. We’ll assess your warts and recommend the best option.

Always contact the dermatologist if a wart is causing pain, changes in color or appearance, and for all genital warts.

Eye disorders: understanding the causes, symptoms and management

Assuming that there are no alarm symptoms that require investigation in this man, it would be appropriate to advise the use of chloramphenicol if bacterial conjunctivitis is suspected, or if an allergic cause is suspected then a product containing an antihistamine or mast cell stabiliser.

Optometrist opinion

From such brief symptoms, it is difficult to accurately assess the condition; the ‘on and off’ frequency of his gritty red right eye may be caused by an allergic conjunctivitis, where exposure to the allergen could be seen to vary. Infective conjunctivitis is also a possibility with its intermittence either owing to reinfection through cross-infection from sharing his friend’s eye drops or from poor compliance if the drops used were indeed appropriate, but not used at the correct dosage or time period. An intermittently red/gritty eye can also be caused by reduced lubrication from a poor quality tear film leading to a dry eye: this can present unilaterally or bilaterally and often varies in frequency, worsening in dry conditions (central heating/air conditioning) and in periods of concentration such as VDU use, where staring at the screen slows down blinking, allowing evaporation of the tear film to take place. The presence of a foreign body is less likely as this more commonly generates persistent rather than intermittent sensation.

Further questions need to be asked in order to rule out alternative diagnoses. Has vision been affected? Is there any photophobia present? Have there been periods of pain rather the current reported grittiness or indeed any discharge noted over the period of the incident? Knowing the name and frequency of the drops used would also help explain their lack of effectiveness. It is also important to establish if the man is a contact lens wearer, as infection associated with lens wear can prove to be more problematic. Contact lenses and their care products have the potential to generate red uncomfortable eyes if improperly used or if tolerance to either has reduced. In the case of contact lens wearers it is best to refer them on to an optometrist.

Optometry practice provides an ideal setting for an eye examination; vision can be accurately assessed and a variety of instruments are available to aid in the examination of the different structures of the eye. In this case, slit-lamp biomicroscopy would provide a well-illuminated and magnified view of the eye. This allows for detailed observation of the anterior segment of the eye, with the location of redness/inflammation and presence of any discharge easily being observed. Further, the cornea can be assessed for the presence of any infiltrates and/or epithelial defects caused by infection, ulceration, abrasion or exposure from drying. This would allow for a more specific diagnosis and appropriate treatment plan.

General practitioner opinion

These symptoms might suggest viral conjunctivitis. Supportive features would include other viral symptoms, e.g. sore throat, coryza. The intermittent nature of these symptoms would point to a possible allergic element. Further questioning may reveal a specific allergen, usually pollen, but the condition may be work related. A history of hay fever or atopy would further support a diagnosis of an allergic conjunctivitis. Identifying the drops that were ineffective would be helpful in coming to a diagnosis. Any visual disturbance, more significant pain or photophobia might suggest other causes and would need referral.

Viral conjunctivitis is self-limiting and does not require treatment. Allergic conjunctivitis can be successfully treated with antihistamines, although local topical treatment is also available and may be more acceptable.

Key points for eye disorders
Conditions Management
Bacterial conjunctivitis is characterised by a redness of the sclera and conjunctiva of the eye along with a gritty sensation and purulent discharge. Chloramphenicol eye drops or ointment for 5 days.
Allergic conjunctivitis is characterised by a redness of the sclera and conjunctiva of the eye along with a gritty sensation. Sodium cromoglycate gives symptomatic relief from seasonal allergies. Eyedrops that contain naphazoline or levocabastine (either alone or in combination):

  • Naphazoline can be used to reduce the irritation of an inflamed conjunctiva.
  • Levocabastine is an antihistamine that will provide fast, symptomatic relief.
Subconjunctival haemorrhage is caused by a burst blood vessel. Heals spontaneously within a few weeks and requires no treatment unless there are accompanying symptoms.
Blepharitis is characterised by a redness and inflammation of the margins of the eyelids. Dibromopropamidine eye ointment applied to the eyelid margins.
Styes are characterised by a localised inflammation of the eyelid. Dibromopropamidine eye ointment can be used in the treatment of styes, but they usually resolve spontaneously.

When to refer an eye disorder:

  • Pain in the eye (in contrast to superficial itchiness, grittiness or soreness);
  • Disturbance in vision;
  • Suspected infection in contact lens wearer;
  • Pupils appear abnormal or uneven;
  • Pupils have abnormal or uneven reaction to light;
  • Upper eyelid drooping (ptosis);
  • Recurrent lump under upper eyelid;
  • Recurrent subconjunctival haemorrhage;
  • Babies under 3 months old or babies with a squint;
  • Existing eye disease;
  • Bulging of eyes (proptosis);
  • Dry eyes (unless previously seen by a doctor);
  • Any associated headache;
  • Systemically unwell;
  • Specific genitourinary symptoms suggesting the possibility of chlamydial infection;
  • Recent long-haul travel in someone whose symptoms are not resolving.
  • This article was adapted from Minor Illness or Major Disease?, published by Pharmaceutical Press.

If you have tiny white bumps on your nose, chin or cheeks, resist the urge to try removing them.

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You likely have milia, a skin condition that’s common among newborns — so common, in fact, that up to half of all babies develop milia.

Milium (that’s the single form of the word!) happen when dead skin cells get trapped beneath the skin’s surface and form small, hard cysts. Milia are common in babies because their skin is still learning to exfoliate, or slough off dead skin cells, on its own.

Although milia are most commonly seen on the nose, chin or cheeks, they can occur on other areas such as the upper trunk and limbs.

In adults, milia fall into two types: primary and secondary. Primary milia are similar to the kind that babies get. Secondary milia happen when a skin condition that leads to blistering damages the pore lining. Burns or severe rashes, for example, can increase the number of skin cells trapped under the skin’s surface.

Leave them alone

Usually, the best treatment for milia is to do nothing, says dermatologist Melissa Piliang, MD. Milia usually disappears in a few weeks.

“If you’re an adult with milia, you might try an over-the-counter exfoliating treatment that contains salicylic acid, alpha hydroxyl acid or a retinoid such as adapalene,” Dr. Piliang says. “These can improve the skin’s natural turnover by removing the dead cells, and may help the bumps go away faster.”

For adults, sun damage can be a contributing factor to milia because it makes skin leathery. This makes it more difficult for dead cells to rise to the skin’s surface and shed normally.

Maintaining a good skin-care routine can help minimize the chance of milia appearing in adults, Dr. Piliang says.

“Because secondary milia can be caused by sun damage, wear a moisturizer or makeup with at least SPF 15 every day to protect your skin,” she says. “I recommend an SPF of 30 in the warmer months.”

If your baby is the one with milia, Dr. Piliang offers these tips:

  • Keep your baby’s face clean by washing her face with lukewarm water every day. If your baby’s skin seems oily, especially around the nose, you can use a mild moisturizing soap that’s formulated for babies.
  • Dry your baby’s face gently by patting the skin dry — do not rub.
  • Don’t apply lotions with salicylic acid or other exfoliating agents meant for adults — a baby’s delicate skin can’t handle it.

It’s important that you refrain from trying to remove the bumps by squeezing or scraping them as you would a pimple.

“Milia are hard and beneath the skin’s surface, so you’ll likely only irritate and damage the skin around the cyst,” she says. “You could wind up scarring the skin permanently.”

When to see the doctor for milia

If your milia don’t respond to an exfoliating treatment after several weeks, consider making an appointment with a dermatologist. The doctor may use a hypodermic needle to remove the cyst, or freeze the cyst and then remove it. Your doctor can also make sure that the milia aren’t something more serious.

If your baby’s complexion doesn’t clear up within three months, consult your baby’s doctor at your next well-baby visit.

Bumps under eyes

The FP diagnosed syringomas in this patient.

He explained that the bumps are benign tumors that occur frequently on the lower eyelids and upper cheeks. They are completely unrelated to the birth control pill and can develop in men, and run in families, too. While syringomas appear to occur more often in women than men, there are no known causative agents. These are benign growths of the eccrine sweat glands.

Treatment options include cryosurgery, electrosurgery, or chemical destruction with trichloroacetic acid. All of these approaches need to be performed carefully, as the syringomas are so close to the eye. Also, these treatments are only modestly effective; new syringomas can form. And there are no preventive treatments.

In this case, the patient had light brown skin, so there was a risk of causing permanent hypopigmentation with any of these destructive methods. The patient was reassured about the benign nature of the condition; she decided not to seek therapy.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Smith M. Epidermal nevus and nevus sebaceous. In: Usatine R, Smith M, Mayeaux EJ, et al. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:958-962.

You can now get the second edition of the Color Atlas of Family Medicine as an app by clicking on this link: usatinemedia.com.

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