What are these white spots around my eyes?

Dear Reader,

Not knowing what’s causing atypical spots on your skin can definitely be a cause for concern, or, at the very least, curiosity. But, there might be a solution to your spotty skin situation. What you describe may be a benign condition called milia, tiny cysts filled with a protein substance called keratin that can appear on the face, eyelids, and elsewhere. To be sure though, it's a good idea to keep an eye on these bumps and have them checked out by a medical professional. They can help determine the cause (be it milia or something else — keep reading for more on other possibilities) and discuss possible treatment options.

More on milia: they're common (especially in infants) and can reoccur in some people. In adults, the spots are called “benign primary milia” and are most often associated with the cheeks, forehead, eyelids, and genitalia. While milia aren’t usually caused by disease, medication, or trauma, sometimes they can be the culprit. They may develop in areas of the skin that have been damaged due to burns (including severe sunburn), radiation therapy, blistering skin conditions, heavy use of steroid creams, rashes, dermabrasion or other skin problems or procedures. Some people experience “multiple eruptive milia” in which many bumps develop on the body over a period of a few weeks, likely caused by a genetic skin condition. Milia can sometimes stick around for a while or they might resolve on their own. There’s no proven technique for preventing these spots, but there are potential removal techniques that can be performed by a medical professional. Removal typically involves expressing (squeezing) out the keratin stuck inside the characteristic bumps. It’s best to leave this to a professional though, rather than attempting it yourself, to avoid skin infections.

It’s also possible that the spots you’ve noticed aren’t milia. You mentioned the prospect that the bumps on your skin are “sweat bumps” or “calcium deposits.” Miliaria (sweat bumps), is characterized by a heat rash that manifests as tiny, clear bumps under the skin. Miliaria, as opposed to milia, is caused by sweat getting stuck inside the pores, and the condition may cause itchiness and discomfort. On the other hand, calcium deposits may look similar to milia, but they are filled with a chalky, white substance. Further, calcium deposits are uncommon on the eyelid and tend to be bigger than milia. Other conditions that may appear in somewhat similar ways on the skin include styes, moles, and acne, which all have distinctive characteristics that differentiate them from milia (check out the Go Ask Alice! Skin Conditions archives for even more information on bumps and spots that can occur on the skin).

Taking action to get to the bottom of these mystery spots may help you find some solutions. A possible next step might be to make an appointment with a dermatologist or your health care provider. These spots may be harmless and go away on their own, but talking with a medical professional could help you learn more about what is causing yours in particular and what can be done about them. It’s also wise to be on the lookout for changes with these bumps. Though you mention that the spots are painless (milia typically are), if they ever become warm, red, or swollen, this may indicate that you have an infection. What’s more, if the white spots are somewhere other than the external eyelid, and are instead under the eyelid (where it’s lined with pink membrane), in the tear ducts, or on the eyeball itself, it may be a sign of something more uncomfortable or serious, such as an infection, injury, or inflammation.

Having spots appear on your face can be frustrating, but it may be helpful to remember that all bodies are unique and different. No matter what you’re dealing with (as these spots may only be skin-deep), a strong dose of confidence and self-acceptance can also be a useful, complementary treatment!