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Différence grain milium et point blanc.

What is the difference between a whitehead and a milium cyst?

Milium cysts are often mistaken for whiteheads. Indeed, their similar appearance can lead to confusion. In this article, we will explore how to differentiate a milium cyst from a whitehead.

Summary
Published March 25, 2024, by Kahina, Scientific Editor — 6 min read

The similarities between milia and whiteheads.

  • Appearance. The milium cysts and the whiteheads, also known as closed comedones because they do not have an opening on top, both have a subcutaneous pimple-like appearance filled with matter, with a thin layer of skin covering this substance. They also share a whitish to yellowish colour. Generally, milium cysts and whiteheads are small, ranging from 1 to 3 mm in diameter.

  • Hazardousness. Whiteheads and milia are not dangerous. They are not contagious and their presence does not affect physical health. Moreover, they disappear spontaneously.

  • Treatments. As previously mentioned, milia are benign, as are whiteheads. They do not require any specific management and disappear on their own. However, their presence can be aesthetically bothersome. To expedite their departure, procedures exist. Generally, we find almost the same techniques in both cases, including extraction using a comedone extractor, skin resurfacing with laser, and the use of topical retinoids.

    These treatments should be carried out by healthcare professionals. You should never attempt to remove a milium cyst or a whitehead by yourself.

The differences between milia and whiteheads.

  • Button content. A milium grain is generally caused by the obstruction of hair follicles due to an accumulation of keratin, old cells that do not shed. New skin develops over it and traps it under the skin to form a cyst. It contains neither sebum nor bacteria, and is rather hard to the touch.

  • follicular plug that forms when the opening of the hair follicle is blocked by sebum, bacteria, and dead cells that remain under the skin surface, resulting in the formation of a bump that is tender to the touch.

  • Factors of Appearance. Although their origin is poorly understood, several factors are assumed to contribute to the appearance of milia : heredity, spontaneous appearance due to follicle obstruction, trauma (skin abrasion, burn), exposure to UV rays, the application of topical corticosteroids, and an association with dermatological diseases.

    A whitehead is often linked to theinfluence of androgen hormones, as the sebaceous glands are highly sensitive to them. When levels of androgens, such as testosterone, significantly increase, the sebaceous glands are hyper-stimulated, leading to an excessive production of sebum. This sebum becomes trapped under the skin, giving rise to a whitehead.

  • Areas of Occurrence. Milium cysts primarily appear on the face, specifically around the eyes, cheeks, forehead, and nose. They can also be seen on the ears, eyelids, and even on the genital areas when they occur in infants. Conversely, whiteheads are generally found on the chin, cheeks, forehead, and corners of the mouth.

  • Affected Individuals. Milium grains can be found in both adults and children, even in newborns, who are indeed the most affected by this condition. Whiteheads, on the other hand, are common in adults and mainly teenagers due to hormonal changes. It is also possible to observe them in babies, but less frequently. Moreover, the appearance of whitish bumps in infants often leads to confusion, as these are most of the time milium grains.

  • Duration. Overall, a milium can last from a few weeks to a few months, then disappear spontaneously. It is extremely rare, but it can persist. This applies to secondary milia related to trauma, medication, or a skin disease. A whitehead does not last more than a week, then it resolves on its own.

Milium cystWhitehead
AppearanceA subcutaneous spot filled with trapped material beneath the skin.A subcutaneous spot filled with trapped material beneath the skin.
ColourFrom whitish to yellowish.From whitish to yellowish.
SizeFrom 1 to 3 mm in diameter.From 1 to 3 mm in diameter.
HazardousnessBenign, not contagious, disappears spontaneously.Benign, not contagious, disappears spontaneously.
TreatmentsPurely aesthetic treatments such as comedone extraction using a comedone extractor, laser skin resurfacing, and the use of topical retinoids. Do not attempt to remove by yourself.Purely aesthetic treatments such as comedone extraction using a comedone extractor, laser skin resurfacing, and the use of topical retinoids. Do not attempt to remove by yourself.
Button ContentKeratin from old cells, hard to the touch.Sebum + bacteria + dead cells, soft to the touch.
Factors of OccurrenceHeredity, spontaneous emergence due to obstruction of hair follicles, trauma, UV rays, topical corticosteroids, dermatological diseases.Androgen hormones.
Areas of AppearanceFace (eyes, cheeks, forehead, nose, ears, eyelids) and genital areas.Face (chin, cheeks, forehead, corners of the mouth).
Individuals AffectedMore common in newborns.More common among teenagers.
DurationA few months to a few weeks.No more than a week.

Sources

  • BERK D. R. & al. Milia: A review and classification. Journal of the American Academy of Dermatology (2008).

  • ROHRIG B. Demystifying gross stuff. ChemMatters (2011).

  • SANKAR R. Acne-causes and amazing remedial measures for acne. Indo American Journal of Pharmaceutical Research (2015).

  • GALLARDO AVILA P. & al. Milia. StatPearls (2023).

  • AMARAL M. H. & al. Treatment advances for acne vulgaris: The scientific role of cannabinoids. Cosmetics (2024).

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