Symptoms

Semolina (milia) - causes and treatment

Semolina (milia) - causes and treatment


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Grain grains are small cysts under the skin surface, one of the three different types of benign skin cysts (in addition to epidermal inclusion cysts, also epidermoid cysts, and pilar cysts, also trichilemmal cysts). They form at the sebaceous gland exits and are clearly visible from the outside. They mainly appear around the eyes and face. They can easily be mistaken for blackheads, even though they are clearly different from them in tissue terms. Cysts form voids in the tissue that can be filled with various substances. They are covered by a thin layer of tissue, the top layer of skin and mucosal tissue.

The technical term originating from Latin is milia (single milium) and literally means millet grains. This designation corresponds to its appearance, based on the color, shape, consistency and size. The term grits probably goes back to the irregular distribution pattern in the skin tissue. They occur individually or in groups and do not follow a fixed pattern in the distribution.

The milia cysts are filled with keratin, a corneal fiber protein, and form small nodules. The material gives them a firm consistency that becomes harder over time. They look white to yellowish. The closer they are to the surface of the skin, the brighter they appear. Their size can vary, the diameter is about one to two millimeters. Milia have no disease value, but are a cosmetic problem because of their good visibility.

Distribution pattern

Milia often appear on the face. The cheeks and temples and the region around the eyes are often affected. The eyelids can also be affected. Other areas of the body where they occur are the genital area and the cleavage. Basically, they can occur in all age groups and in both sexes. Young women and menopausal women are the most frequently affected. Semolina can also occur in newborns.

Types of grits and causes

Medically a distinction is made between primary and secondary milia. The primary semolina is produced without a recognizable cause and shows the typical pattern of infestation. The affected regions on the face and around the eyes stand out visually. Due to the fact that young women and menopausal women are often affected, the scientists suspect a connection to the female hormone balance.

The scientists also interpret the occurrence of milia in newborns in the same direction. They suspect that female hormones that are transferred from the mother to the embryo are responsible for the occurrence after birth. This assumption is also supported by the fact that boys are affected more often than girls. So far, no evidence for the hormone thesis has been found. The medical team also suspects that genetic factors are involved, as the increased occurrence has been observed in some families. As described above, primary milia develop at the exits of the sebaceous glands and do not usually heal on their own. An exception are the semolina grains in newborns, which usually completely degenerate within a few weeks.

The secondary form of the semolina is caused by skin injuries. This can be small cuts, abrasions on the skin, sunburn or local inflammation. The milia develop exactly at the point of the injury. In rare cases, they can also be a result of shingles. They typically only develop after the disease has healed. Secondary semolina grains usually disappear completely within a few weeks after the triggering cause has disappeared.

Symptoms

The whitish-yellowish semolina grains feel very firm, as described. This is a differentiator from blackheads that are softer and deformable, which in turn is related to the different fillings. While the cutouts of the cutaneous cysts are filled with resistant horn material, blackheads inside consist of a fatty substance. Due to the stored melanin, they can turn dark over time. Blackheads always cause local inflammation, which is noticed as reddening in the edge area. This is completely absent from the milia because they have no potential to cause illness.

What to do about semolina

Milia have no disease potential. They don't hurt and don't cause inflammation. So there are no medical reasons for treatment. For the affected, mostly young women, they represent a cosmetic and visual problem that should not be underestimated. They stand out directly on the face and around the eyes and every look in the mirror immediately reminds one of the disturbing roommates. The certainty that they will not go away on their own increases the desire to get rid of them as quickly as possible.

Despite the visual similarity, the so-called expression is not recommended, just as with blackheads. Otherwise, due to the strength of the milia, pain, inflammation, and even injury with scars can occur. In addition, the joy of a successful removal is usually short-lived. As a rule, the granules return after a short time because the epithelial covering has not been completely removed.

Invasive procedures

If the number of semolina grains is not too high, they can be permanently removed by a dermatologist or an experienced beautician. To do this, they use a special procedure that has no ugly and unpleasant consequences. The semolina is first opened with a small incision using a lancet or a sharp cannula, sometimes also using a comedone squeezer. This releases the blockage of the exit from the sebum gland by the skin above. There is no longer any resistance and the semolina can be carefully pressed out. When used professionally, this procedure often leaves no noticeable and visible consequences, including no scars.

Such treatment should be carried out in the hands of experienced professionals, especially if the milia are large or are located in sensitive areas. This is the case with the eyelids, for example. Another way to remove milia mostly without negative consequences has opened up through the development of laser medicine. This has long been used by dermatologists for skin problems on the face. Studies have shown that an erbium laser is particularly suitable for removing milia. With its help, the covering skin layer is first removed in a targeted manner. The keratin substance is then evaporated in the cave. This creates a small crust that usually heals without complications and without a scar. This leaves smooth skin without cysts. However, the new skin is still very sensitive for a few days. Therefore, doctors recommend avoiding direct sunlight during this time.

The earlier the presented invasive methods are used, the less complex they are because the keratin substance has not yet solidified so much. The decision whether or not to treat a milieu infestation is left up to the individual concerned, since there is no medical indication for therapy. The driving force behind having the annoying semolina removed is based on subjective feeling. This is very much influenced by the visual impression. Accumulations of many large and clearly visible milia will increase the desire to have them removed and to consult an expert. Patients have to bear the costs themselves. They are not covered by the health insurance company, as semolina is not classified as an illness.

Home remedies

Home remedies aim to influence the external conditions of the skin, especially on the face, in such a way that the plugs stuck in the sebaceous glands can loosen. For this purpose, substances and methods are used that are generally known from facial cosmetics and hygiene. However, special attention is paid to active ingredients and processes that are suitable for opening the pores and softening the keratin substance. In principle, these applications can reach milia that have not yet become too firmly established or are still in the making. Established and heavily encapsulated grains cannot usually be removed with it.

Skin cleansing and careful peeling

First of all, it is important that those affected make sure to clean the skin regularly and thoroughly. This prevents additional deposits of dead skin particles or dirt particles on the sebaceous gland exits. For example, a mixture of apple cider vinegar and corn starch is suitable for this. The vinegar regulates the pH of the skin and has an anti-inflammatory effect. The corn starch binds excess sebum. Tea tree oil is also often mentioned in connection with skin problems. Its native antibacterial properties are said to have been known to Australian Aborigines for centuries. The oil can simply be applied to the affected areas of the skin and washed off thoroughly later, for example overnight.

Another good way to keep the skin clean and supple is to use peelings. A mixture of olive oil, lemon juice and sugar grains is very suitable for this. The olive oil improves the moisture content of the skin, while the lemon juice promotes blood circulation. The sugar grains cause the peeling effect and gently remove skin residues and dirt particles. Similar effects can be achieved with a honey peeling. For this, two tablespoons of honey are mixed with a tablespoon of jojoba oil and a tablespoon of granulated sugar. Then add three tablespoons of oatmeal to make a paste. This is carefully massaged into the skin and rinsed off thoroughly after a few minutes.

The procedure should be repeated once or twice a week. The effects of the sugar and the oil are the same as with the previous peeling. The honey can also be anti-inflammatory on the skin and is said to help improve the environment by binding free radicals. Peels mechanically stress the skin. Therefore, subsequent care is important. The usual creams that are available for this are not suitable for milieu infestation because they contain too much fat. This settles and closes the pores of the sebaceous glands opened by the previous application.

It is best to mix yourself a cream from substances that care for and protect the skin, for example with chamomile tea or green tea and healing earth. Another classic measure that can be used against milia with or without a peeling effect is a face mask. A mixture of rose water and sandalwood is very suitable for this. For the mask, two spoons of sandalwood powder are made into a paste with the water. It is applied to the face and left on the skin for 15 to 20 minutes. During this time, the rose water can develop its toning effect on the skin. Excess sebum particles are released from the skin and can be removed during subsequent cleaning.

The peeling effect of sandalwood has proven itself. Applying this procedure once a week can effectively open your pores and help loosen milia that are not yet tight. Basically, peels should be used with caution. Substances that mechanically stress the skin have a negative effect. They stimulate sebum production and increase the constipation effect. That is why only peels with small-grained additives are listed here.

Heat applications

Very warm effects for relaxing and cleaning the skin and for opening the pores can have warm, moist applications with or without additives. For a facial sauna, a clean cotton cloth is soaked in hot water and wrung out. Then it is placed on the face for three minutes. The process should be repeated several times and the procedure should be carried out at least once a week.

A facial steam bath has a similar effect, in which the head, covered with a towel, is held over a bowl of hot water. The application takes about ten minutes and should be done three times a week. Additions from apple cider vinegar and castor oil enhance the effect.

Prevention

Not only is the removal of milia important, but also prevention to prevent the new generation. This is particularly true in order to obtain the results of previous measures to eliminate them. The following list shows some preventive measures against semolina:

  • Avoid UV radiation because too much UV light can trigger the formation or aggravate the further development of milia.
  • All home remedies that help soften the skin and keratin granules are also good for prevention.
  • Thoroughly cleanse the face regularly, preferably with warm water, possibly mixed with chamomile tea or green tea.
  • Regular visits to a beautician for complete deep cleansing can be useful.
  • Avoid fatty creams during facial care.

A final remark. Semolina grains are very stubborn and very resistant to external applications. Therefore, there is no guarantee that the advice on remediation and prevention presented here will actually be successful. Nevertheless, they are worth trying, if only because they are good for the skin as a whole and can promote well-being. If a visit to the dermatologist or beautician is still necessary, they are useful afterwards to ensure the result of the procedure. (fp)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Geogr. Fabian Peters

Swell:

  • Denise M. Aaron: Cutaneous Cysts, MSD Manual, (accessed July 4, 2019), MSD
  • Alexander Nast, Christiane Bayerl, Claudia Borelli et al .: S2k guideline on acne therapy, German Dermatological Society (DDG), (accessed July 4, 2019), AWMF
  • Christine Frances Carson, Katherine A. Hammer, T.V. Riley: Melaleuca alternifolia (Tea Tree) Oil: A Review of Antimicrobial and Other Medicinal Properties, Clinical Microbiology Reviews, (accessed 04.07.2019), CMR
  • Dorothea Terhorst-Molawi: Dermatologie Basics, Elsevier / Urban Fischer Verlag, 4th edition, 2015
  • Martin Röcken, Martin Schaller, Elke Sattler, Walter Burgdorf: Taschenatlas Dermatologie, Thieme Verlag, 1st edition, 2010

ICD codes for this disease: L72.0ICD codes are internationally valid encryption codes for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.


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