How can I tell milia from sebaceous hyperplasia at home?
Look at the middle of the bump in side lighting. Milia are smooth all over and white. Sebaceous hyperplasia is yellowish with a small dent in the centre.
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Dermapedia / CompareConditions
Milia vs Sebaceous Hyperplasia
Milia are tiny keratin cysts sealed just under the surface of the skin. They are white, firm, smooth on top, and about the size of a pinhead. Sebaceous hyperplasia is an oil gland that has grown too large. Those bumps are yellowish, softer, a little bigger, and most have a small dip in the middle. Look for the dip. A dimple in the centre means sebaceous hyperplasia.
At a glance
| The difference | Milia | Sebaceous Hyperplasia |
|---|---|---|
| What it is | A tiny cyst full of keratin | An oil gland that has overgrown |
| What it looks like | A smooth white or yellow bead | A yellow bump with a dent in it |
| Does it feel hard or soft | Hard | Soft |
| What it does over time | Often clears on its own | Stays, and more appear |
| Treatment | A pinpoint nick and gentle pressure | Heat, laser or a light acid |
Side by side
The differences that matter
What it is
Milia
A tiny cyst full of keratin
Keratin is the protein that makes up the surface of your skin. A small amount gets sealed into a closed pocket, with no opening for it to come out of.
Sebaceous Hyperplasia
An oil gland that has overgrown
The gland keeps making oil but drains poorly, so it swells and pushes the skin up. The bump is the gland itself, not a blockage sitting inside a pore.
What it looks like
Milia
A smooth white or yellow bead
Round, dome-shaped, even in colour, with no opening and no dip on top. It looks like a grain of sand under the skin.
Sebaceous Hyperplasia
A yellow bump with a dent in it
Soft, doughnut-shaped, cream to yellow, with a small crater in the middle. Fine blood vessels often run across the surface, but they stop at the edge of the bump.
Size
Milia
One to two millimetres
Pinhead-sized, and it stays that size.
Sebaceous Hyperplasia
Two to five millimetres
Bigger than a milium, and often a small group sits together on the forehead or a cheek.
Does it feel hard or soft
Milia
Hard
Press it and there is a firm bead that does not squash. Nothing comes out, because there is no opening.
Sebaceous Hyperplasia
Soft
It gives under a fingertip. Squeezing can push out a little oil, and the bump refills within days.
Where it shows up
Milia
Around the eyes
Eyelids and under the eyes most of all, then the nose, cheeks and forehead. Newborns get them across the nose and chin.
Sebaceous Hyperplasia
Forehead, nose and cheeks
The oiliest parts of the face, in adults from about their forties onwards.
Where it appears
Milia
Eyelids, under the eyes, cheeks and nose
Milia turn up most often on the eyelids, under the eyes, and on the cheeks, nose and forehead. In newborns they sit across the nose, chin and cheeks, and sometimes on the gums or the roof of the mouth. They are firm and white, and they do not come to a head.
What it does over time
Milia
Often clears on its own
Milia in babies clear within a few weeks. In adults they often sit quietly for months, and some stay for years.
Sebaceous Hyperplasia
Stays, and more appear
An individual bump does not resolve. New ones tend to arrive on the same areas over the years.
Treatment
Milia
A pinpoint nick and gentle pressure
A clinician opens the surface with a sterile needle and lifts the keratin out. It takes seconds per bump, usually needs no anaesthetic, and heals over within about a week.
Sebaceous Hyperplasia
Heat, laser or a light acid
Electrocautery flattens the gland with a fine heated tip. Laser and trichloroacetic acid do the same job. Each bump takes a few seconds, and one treatment usually settles it.
Milia
Adapalene
The over-the-counter retinoid, used at night. It speeds up how the duct lining sheds, which over two to three months lowers how many new milia form. It will not open or empty the ones you already have, because nothing applied to intact skin can reach a sealed sac. Start a few nights a week, and keep it off the eyelids themselves. Ask your doctor about it if you are pregnant or trying to become pregnant.
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Salicylic Acid
A gentle leave-on exfoliant that helps keep small ducts clear, which is prevention rather than treatment. It does nothing to a milium that has already sealed over. Low strength, a few times a week, and not on eyelid skin, which is thin and irritates easily.
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Glycolic Acid
Keeps the surface layer shedding evenly, on the same prevention logic as salicylic acid. Low strength only. Strong glycolic peels are the opposite of helpful here — deep peeling is one of the recognized causes of milia in the first place.
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A daily sunscreen
Not a milia treatment, and it will not stop new ones forming. It is here for what is left behind: a mark from an extraction or from picking darkens and lasts longer with sun on it, and that matters more on deeper skin tones. The useful window is the few weeks after a bump has been removed.
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A lighter cream around the eyes
Thick eye creams and balms get blamed for milia constantly. The evidence is weak and plenty of people get milia while using nothing at all, so this is not a reliable fix and it will not clear the bumps already there. If you keep getting them in the exact spot where a heavy product sits, switching to something lighter costs nothing and is worth trying.
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Scrubs, brushes and pore strips
These are what most people try first, and they cannot work. A scrub abrades the surface, and the sac sits under an intact surface. A pore strip needs an opening to grip, and a milium has none. What scrubbing does achieve is irritation, which is not neutral here, because repeated injury to one area can seal off new ducts.
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Comedone Extraction
The definitive treatment, and the only thing that actually empties a milium. The roof is nicked with a sterile blade or needle and light pressure lifts the keratin pearl out whole, in about ten seconds a bump. The one that is removed does not come back in that spot. Done once, properly, it heals in a few days; repeated digging at the same place is what leaves marks.
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Electrodesiccation and Curettage
A fine heated needle used to destroy the sac, usually kept for milia that are numerous, very small, or sitting somewhere awkward for a blade. It works. It is also more likely than a simple nick to leave a small mark, so it is not the first choice for one or two bumps on an eyelid.
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Cryotherapy (Liquid Nitrogen)
Freezing is sometimes offered for milia. It is less precise than extraction, more uncomfortable, and on deeper skin tones it carries a real risk of leaving a pale or dark mark where the bump was. There is little reason to choose it over opening the sac and lifting the contents out.
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Tretinoin
The prescription-strength version of the same idea as adapalene, used at night when there are many milia or they keep coming back. Over two to three months it reduces how many new ones form. It does not clear the existing bumps, and it is used carefully near the eyes. Ask your doctor about it if you are pregnant or trying to become pregnant.
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When it needs a doctor
Milia
Only if you want them gone
Milia are harmless. The reason to hand this over is that eyelid skin is thin and easy to mark.
Sebaceous Hyperplasia
If one grows or bleeds
Sebaceous hyperplasia is harmless too. But a yellow bump that keeps growing, bleeds or crusts is worth checking, because basal cell carcinoma can look similar.
The centre of the bump settles it
Sebaceous Hyperplasia
Sebaceous hyperplasia has a crater in the middle. Stretch the skin gently and look in good light from the side. The rim sits up and the centre sinks, so it looks like a tiny doughnut. That dip is where the gland's duct opens onto the surface.
Why one squeezes and one does not
Milia
Milia cannot be squeezed out. The pocket is sealed. Pressure only bruises the thin skin over the top, which on the eyelid leaves a brown mark or a small dent. This is a two-minute job for someone who does it every week.
Sebaceous Hyperplasia
Sebaceous hyperplasia comes back when you squeeze it. A little oil comes out, the bump looks flatter for a day, and then the gland refills. The gland is still there. Only treatments that shrink or destroy the gland make a lasting difference.
What creams do for each one
Milia
A retinoid cream clears milia slowly. It speeds up how fast the surface layer sheds, which helps trapped keratin work its way out. Expect weeks to months, not one evening.
Sebaceous Hyperplasia
A retinoid cream helps sebaceous hyperplasia a little. It can keep new bumps from forming and soften the look of the ones you have, but it will not flatten an established gland. Isotretinoin tablets shrink these glands well, and the bumps usually return after the course ends.
What else looks like both
Related topic illustrations
Milia
Acne
The closed comedone — a whitehead — is what milia get mistaken for most. Both are small pale bumps in the same places. A whitehead is a blocked pore, so it has an opening you can find, it holds oil and skin cells rather than a firm pearl, it can turn red and sore, and it comes and goes over days. A milium is sealed, has no opening, sits unchanged for months and never becomes inflamed. That is also why acne treatments do very little for milia.
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Molluscum Contagiosum
Both are small, firm, dome-shaped and pale. Molluscum bumps are usually a little larger, most have a tiny dimple in the middle, they turn up in clusters that spread over weeks, and they are common in children and in skin folds. Milia do not spread, do not dimple and cannot be passed on. Molluscum is a virus and clears on its own eventually; a milium sits still until someone removes it.
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Basal Cell Carcinoma
Worth knowing about, because an early basal cell skin cancer can look like a small pearly bump on the face, which is exactly what a milium looks like. The difference is behavior. A basal cell grows slowly month by month, often has fine blood vessels visible over its surface, and may crust, bleed or refuse to heal. A milium is one to two millimetres, stays that size and never bleeds. A single bump that is growing or bleeding should be looked at.
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Common questions
Questions Patients Ask
Can sebaceous hyperplasia be squeezed out?
No. A little oil may come out and the bump flattens for a day, but the enlarged gland is still there and it refills. Squeezing also risks bruising and marking the skin.
Does sebaceous hyperplasia mean my skin is too oily?
Not exactly. It is more about the gland enlarging with age than about how oily your skin is now, although it is more common in people who have oily skin.
Will salicylic acid clear either one?
It does very little for either. Salicylic acid works on plugged pores. Milia are sealed cysts and sebaceous hyperplasia is an enlarged gland, so neither is a pore that can be unblocked.
Do these bumps ever turn into skin cancer?
No. Both are benign and neither becomes cancer. The reason a doctor looks at a yellow bump is that basal cell carcinoma can resemble sebaceous hyperplasia, not that one becomes the other.
How long does treatment take to work?
Removal in clinic is immediate for both, a few seconds per bump. Creams are slow: expect two to three months before you can judge a retinoid.