眼周小白点未必是白头：粟丘疹是什么、怎么处理才不留疤
It’s Not a Whitehead, It’s Milia—Here's How to Treat It
眼下、脸颊或鼻子周围冒出的珍珠色小白点，常常被当成白头粉刺去挤，但它可能是粟丘疹：一种藏在皮肤表层之下、装着角蛋白的小囊肿。它不发炎、不传染，也和痤疮无关，摸起来更硬、位置更深，不会像白头那样冒头。成因是死皮细胞与角蛋白本该脱落却被困在表层之下；厚重封闭的产品、浓重的眼霜、卸妆不彻底，以及炎热潮湿环境都可能助长它，凡士林、矿物油、羊毛脂、蜂蜡等封闭性成分被原文点名。粟丘疹分两类：原发的常出现在新生儿和成人的眼睑、脸颊，继发的来自烧伤、水疱、疤痕或某些医美操作后的皮肤损伤；也有成片出现在发炎皮肤上等少见类型。处理上，原文的共识是温和与耐心：维A类帮助角质更新，果酸、水杨酸帮助温和去角质，但眼周皮肤薄，必须防过度去角质，更不要自己拿针挑——自行处理可能留疤。日常预防没有一劳永逸的办法，易发者可避开眼周厚重封闭产品、坚持温和去角质并每日防晒，因为慢性日晒损伤也是成人原发粟丘疹的常见诱因。持续不退或影响外观时，皮肤科医生可在诊室用无菌针、冷冻、电灼或激光等方式处理；若多发突然暴发、伴皮疹或与所用药物有关，应就医排查。证据限制：以上为四位皮肤科医生在原文中的临床共识，原文未引用对照试验数据，个体情况差异大，本文不能替代面诊；原文夹带的产品清单属购物模块，不构成购买推荐。
It’s easy to mistake them for whiteheads: Small, pale bumps that crop up overnight, clustered under the eyes, on the cheeks, or along the nose. But before you pick up your tweezers or get to squeezing them (bad!), listen up—what looks like a mild breakout or whiteheads could actually be milia, a completely different kind of skin concern that won’t respond to your tried-and-true acne spot treatment, and definitely not to squeezing.
“Milia are tiny cysts that sit just under the skin’s surface,” explains cosmetic physician and head of education at Acquisition Aesthetics Emmaline Ashley, MD. “They are full of a protein called keratin, which is commonly found in your hair, nails, and the outer layer of skin.” Milia presents itself as pearly-white bumps; however, they are not inflammatory, infectious, or even remotely related to acne.
Whiteheads, on the other hand, are a type of acne lesion caused by clogged pores that are filled with sebum, dead skin, and bacteria. “Milia, however, are firmer, deeper-set, and won’t extract easily like a whitehead,” warns Dr. Ashley.
Key Takeaways
- Milia are tiny cysts that sit under the skin’s surface.
- They are generally harmless, but you can use retinoids and chemical exfoliants to treat it at-home. Other tips include avoiding heavy or occlusive products and wearing SPF daily.
What causes milia?
Our skin isn’t just a protective barrier. It’s a living, breathing organ that renews itself once a month. As part of this natural cycle, dead skin cells are meant to shed from the surface, making way for the fresh, healthy ones beneath. But sometimes, that process doesn’t go quite as planned, causing milia.
These tiny, pearly bumps form when dead skin cells and keratin become trapped beneath the surface, rather than exfoliating as they should. They most often appear around the eyes and cheeks, delicate areas where the skin is thinner, making them more susceptible to buildup.
“Clinically, milia are smooth, dome-shaped, and feel firm to the touch,” says Dr. Ashley. “Unlike a whitehead, they don’t come to a ‘head,’ they’re not red or inflamed, and they’re usually not tender or painful unless irritated.”
According to Hussein Yassine, MD, board-certified dermatologist and founder of Skin Expert Clinic, milia is often found in newborns and in adults with dry or damaged skin and can be triggered by multiple factors, one of them being the use of occlusive ingredients or very thick, hydrating formulas—they contribute by disrupting natural exfoliation.
“A lot of people consider petroleum jelly, like Vaseline, to be a moisturizer, which it is not,” he explains. “Not to forget the use of mineral oils, lanolin, beeswax, paraffin, and other rich natural oils, as well as cocoa and shea butter.” Even ingredients like dimethicone, commonly found in makeup, can contribute to congestion when layered too heavily. Overusing rich eye creams, failing to properly remove makeup, or relying on occlusive products in hot, humid climates can also create the perfect conditions for milia to form.
The Different Types of Milia
Milia is categorized into two general types: primary and secondary. Primary milia form on their own, explains Corinne Erickson, MD, board-certified dermatologist and owner of Georgia Skin Specialists, and are often seen on newborns as tiny white bumps or the ones that appear on adult eyelids and cheeks for no obvious reason. Secondary milia comes from skin injury, such as a burn, blister, scar, or certain cosmetic procedures, adds Celina Feldman, MD, board-certified dermatologist and assistant professor at the Icahn School of Medicine at Mount Sinai.
There are rarer forms of milia, such as milia en plaque, which Dr. Erickson says is a clustered patch on inflamed skin, and multiple eruptive milia, which are a group of cysts that form over the course of a couple of weeks to months on your upper arms, stomach, and your face and can sometimes be very itchy.
Where does milia happen?
You’re most likely going to find milia on the eyelids, the under-eye area, cheeks, nose, and forehead, says Dr. Erickson. But they can also show up on your ears, on the back of your hands, chest, and genital area. For newborns, milia can appear inside the mouth. For secondary milia, she says they are most likely going to show up at sites of trauma or inflammation.
How to Treat Milia
When it comes to at-home care, consistency is key. Gentle exfoliating ingredients can gradually help reduce milia and prevent new ones from forming. Look for formulas that include retinoids to boost cell turnover and minimize keratin buildup, as well as AHAs and BHAs—especially if you’re also managing acne or congestion. But tread carefully. “Because milia tends to occur around delicate areas like the eyes, it’s important to be careful,” warns Dr Ashley. “Avoid over-exfoliating and do not attempt to extract them yourself at home.”
Medicube
Zero Pore Pads
Paula's Choice
Skin Perfecting 2% BHA Liquid Exfoliant
Sofie Pavitt Face
Mandelic Acid Exfoliating & Clearing Serum
Some By Mi
AHA BHA PHA 30 Days Miracle Toner
CeraVe
Resurfacing Retinol Serum
U Beauty
Resurfacing Compound
Medik8
Surface Radiance Cleanse
Chanel
N°1 de Chanel Revitalizing Mask
Is milia harmful?
If you happen to have milia, there’s no need to panic. Milia are harmless, for the most part. “Ordinary milia are completely harmless,” says Dr. Feldman. “They don’t become cancerous, spread throughout the body, or cause systemic disease. They’re primarily a cosmetic concern.” If you’re experiencing widespread or unusual milia, she says that can be associated with an underlying skin disorder. That’s when she’d recommend you see a dermatologist.
Can you prevent milia?
Dr. Feldman says that there is no guaranteed way to prevent primary milia because they can occur spontaneously. But if you’re prone to getting them, she recommends avoiding heavy or occlusive products around the eyes, exfoliating your skin aggressively, and constant picking at your skin.
Experts also agree that maintaining a healthy skin barrier and committing to a consistent, but gentle, exfoliation routine can significantly reduce your risk. Choose non-comedogenic, lightweight products around the eyes, avoid heavy occlusives that trap dead skin and keratin, and consider incorporating a mild chemical exfoliant once or twice a week. Dr. Erickson says that you’ll also want to incorporate regular use of topical retinoids as well, to help promote skin cell turnover. “Always use SPF daily,” Dr. Ashley adds. “As chronic sun damage is a common contributor to primary milia in adults.”
Clinique
Moisture Surge 100H Auto-Replenishing Hydrator
Blue Lagoon Skin Science
BL+ Eye Cream
Allies of Skin
Copper Tripeptide & Ectoin Advanced Repair Face Serum
SkinCeuticals
Physical Fusion UV Defense SPF 50
When to Seek Professional Treatment
In most cases, milia is harmless and tends to resolve on its own with time. But if it’s persistent—or simply bothersome from a cosmetic standpoint—experts recommend a combination of consistent at-home care and professional in-clinic treatments. “A skilled clinician can use a sterile needle to gently de-roof the lesion,” says Dr. Ashley. “Cryotherapy, diathermy, or even laser ablation can be suggested for more extensive cases.”
Dr. Yassine also recommends retinol or an in-office peel to help regenerate the skin and boost exfoliation. “You can also opt for a series of HydraFacials—they’re one of the most effective treatments for deeply cleansing the pores,” he says.
Dr. Erickson adds that you should see a professional if you have multiple milia erupt at once, if they accompany a skin rash, are related to a medication your doctor prescribed, or if they really bother you. A dermatologist will be able to perform a quick in-office treatment to safely extract the milia. “Milia can be surprisingly stubborn to remove and self-treatment attempts may lead to scarring,” she says. “Resist the urge to perform bathroom surgery.”
Meet the Experts
- Emmaline Ashley, MD, cosmetic physician and head of education at Acquisition Aesthetics.
- Hussein Yassine, MD, board-certified dermatologist and founder of Skin Expert Clinic.
- Corinne Erickson, MD, board-certified dermatologist and owner of Georgia Skin Specialists.
- Celina Feldman, MD, dermatologist and assistant professor at the Icahn School of Medicine at Mount Sinai.
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来源：颜如玉编辑台 · vogue.com