Hard white bumps on the face that won’t pop are usually milia, however, there are several other causes of white bumps.
The white bumps on the face that are not milia, can be due to folliculitis, closed comedones, Molluscum contagiosum, cysts, sebaceous hyperplasia, allergic rash, and rarely pre-cancerous and cancerous lesions.
In this article, we will cover 10 causes of white bumps on the face (including milia), along with pictures and treatment options.
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1. Milia
Milia are small hard white bumps that can appear anywhere on the face especially on the cheeks, nose, and under the eyes. They can look like white pearly lesions.
They are often seen in infants but they can occur at any age.
Why do they occur? Our skin cells go through a cycle of growth and shedding. Sometimes these skin cells don’t slough off, trapping dead skin cells under the skin. These dead skin cells can harden and result in the formation of tiny hard bumps or cysts under the skin.
They may also be related to the following causes:
- Damage to the skin due to a rash, injury, or harsh skincare products.
- Prolonged topical steroid use.
- Sun exposure.
- Autoimmune conditions.
- Genetics.
- Bullous skin conditions can lead to bullae and blisters.
- Procedures like laser skin resurfacing and microdermabrasion.
- Use of heavy cosmetics.
In infants, they are thought to occur due to the mother’s hormones. They can either appear as a single lesion when it is called milium or as a cluster called milia.
Diagnosis
A doctor usually diagnoses these by physical examination of the bumps.
Treatment
White bumps of milia can be annoying but they are harmless and not contagious. They usually go away in a few weeks or months.
One can also use topicals to clear them like:
- Exfoliants (salicylic acid) can remove the top layer of skin.
- Topical retinoids like retinol increase the turnover of the skin cells.
It’s never a good thing to pop milia as it can traumatize your skin leading to inflammation and possible secondary infection.
If over-the-counter treatments do not work, you can visit a doctor who can extract or remove them. They may do the following procedures:
- Extraction by deroofing
- Cryotherapy (freezing of the lesion)
- Chemical peels
- Laser ablation
- Prescription retinoids like tretinoin may be given.
2. Closed comedones
A pimple with a hard white ball inside is a type of comedonal acne known as closed comedones. Comedones form when our hair follicles get blocked by dead skin cells and oil or sebum. They are categorized as non-inflammatory acne lesions.
- These can be either open comedones in which the surface is open and the oils get oxidized resulting in blackheads.
- The second type is closed comedones which don’t have an opening on the surface.
Closed comedones can appear either as skin-colored or white bumps on the skin. They are sometimes referred to as whiteheads. They usually occur on the forehead and chin.
Diagnosis
They can be diagnosed clinically by a doctor.
Treatment
If you try to squeeze them, you can end up with scarring and inflammation.
To treat closed comedones, one can use over-the-counter topicals like salicylic acid, azelaic acid, retinol, and benzoyl peroxide.
If they are persistent, prescription retinoids like tretinoin may be helpful.
3. Folliculitis
White bumps on the face that look like pimples can be folliculitis. Folliculitis is a common skin condition that occurs due to inflamed and infected hair follicles.
Folliculitis is of several types. Bacterial folliculitis often caused by the bacteria Staphylococcus aureus is the most common type.
It may involve any area that has hair. The common areas are the face, arms, legs, and buttocks.
If a hair follicle becomes deeply infected with the bacteria, it can become a boil.
Some risk factors for developing folliculitis are:
- An injury or when skin is broken down letting in bacteria.
- Post-shaving, waxing, or hair plucking.
- Prolonged antibiotic use.
- Heavy sweating if not followed by a bath.
- Hot tubs which are not cleaned well.
- Diabetes.
- Overweight.
- Tight clothing.
Diagnosis
It can be diagnosed clinically by a doctor.
Treatment
Mild cases may resolve on their own. Antibacterial washes may be helpful.
In more severe cases, topical antibiotics like mupirocin may be used. In some cases, oral antibiotics may be needed.
If it develops into a boil, one should see a doctor for proper treatment. In some cases, oral antibiotics are given. A doctor may drain the boil.
It is important to practice good hand hygiene when taking care of boils.
4. Molluscum contagiosum
White bumps with shiny or waxy appearance can be due to molluscum contagiosum.
Molluscum contagiosum is a common viral infection of the skin caused by a pox virus called Molluscum contagiosum virus. It usually occurs in children but it can occur in adults too, especially with suppressed immune systems.
This can occur via direct contact with the lesion or contaminated items/surfaces. It can occur by sexual transmission in adults. It may occur more frequently in children with atopic dermatitis due to defective skin barrier.
It presents with small white, skin-colored, or pink bumps or papules with a central depression. This appearance is sometimes referred to as umbilicated.
They can look shiny or waxy and are filled with white waxy material.
They are usually 1-5 mm in size and appear on the face, trunk, or limbs. They can also appear on genitalia in adults.
Diagnosis
They are usually diagnosed clinically by their appearance. In some cases, a skin biopsy may be done to confirm the diagnosis.
Treatment
They usually disappear on their own and do not require treatment. However, they may take several months or a few years to clear.
In a few cases, several procedures can be done in a doctor’s office to remove them like laser therapy, curettage, or cryotherapy.
5. Allergic contact dermatitis
Allergic contact dermatitis often manifests as red spots; however, it can sometimes result in a rash characterized by tiny white bumps on the skin.
Allergic contact dermatitis occurs when the skin comes in contact with an allergen, such as nickel in jewelry, poison ivy, pollen, dust, and so forth.
Diagnosis
It is usually diagnosed clinically through a review of the patient’s medical history and the appearance of the rash.
Treatment
- Avoid any further contact with the allergen.
- Apply a cool compress to alleviate symptoms.
- The use of antihistamines and topical steroids may assist in reducing symptoms.
- Choose skincare products that are gentle on your skin.
- Avoid wearing metal jewelry that contains nickel.
6. Epidermoid or epidermal cyst
Epidermal cysts are small bumps under the skin, often found on the face, neck, or back. They occur due to injury or blockage of the hair follicle and may be related to genetic conditions like Gardner syndrome.
These are lined with squamous epithelium and filled with keratin. The bumps can appear skin-colored, white, or yellowish. In some cases, they may become inflamed, swollen, and painful.”
Diagnosis
Epidermoid cysts can be diagnosed clinically by a doctor through physical examination and detailed history.
Treatment
Epidermoid cysts may not require treatment unless they are bothersome. Some individuals might choose to remove them for cosmetic reasons, especially when they are on the face.
If the cyst becomes inflamed, intralesional steroids can be helpful. In the case of infection, antibiotics may be necessary.
To completely remove the cyst, surgical excision is required to eliminate the entire wall of the cyst.
7. Fordyce spots
Fordyce spots are small, white, or yellowish bumps that commonly appear on the lips, inner cheeks, and genital area. They are caused by enlarged oil glands and are a typical anatomical variation of the skin.
These spots are non-cancerous, not contagious, and generally harmless.
Diagnosis
These spots can be diagnosed clinically by a doctor by examining the lesions.
Treatment
Treatment for Fordyce spots is usually not necessary unless they cause discomfort or cosmetic concerns. Various treatment options include retinoids, cryotherapy, electrodesiccation, lasers, and micro-punch surgery.
8. Sebaceous hyperplasia
Sebaceous glands secrete sebum or oil on our skin. These glands are attached to our hair follicles. Sometimes these glands can become enlarged by trapped sebum resulting in sebaceous hyperplasia.
These appear as yellow, white, or skin-colored bumps on the skin. They are usually 1-3 mm to several millimeters in size and are seen on the cheeks and forehead of middle-aged to older individuals.
They can be often confused with basal cell carcinoma, a type of skin carcinoma.
Diagnosis
Sebaceous hyperplasia can be diagnosed clinically by a doctor. In a few cases, a skin biopsy may be taken to rule out other skin conditions.
Treatment
They are harmless and do not require treatment unless for cosmetic reasons. Over-the-counter retinoids like retinol may be helpful, although the results may vary.
Prescription-strength retinoids like tretinoin may be more efficient in improving them.
Oral isotretinoin may help by shrinking the sebaceous glands. Anti-androgens can be helpful in decreasing the sebum and shrinking them
In addition, several in-office procedures may be helpful in removing them, although some of these may leave behind areas of discoloration.
- Cryotherapy – These bumps are frozen and then they slough off.
- Electrodesiccation – In this, an electrically charged needle is used to heat and dry the bump.
- Photodynamic therapy – In this, a chemical is applied to the skin and then a special light is used to remove the bumps.
- Laser therapy.
- In some cases, excision, shave, or curettage may be done.
9. Actinic keratosis (Solar keratosis)
Actinic keratosis is a precancerous lesion of squamous cells that appears on sun-exposed areas like the face, lips, ears, scalp, back of hands, neck, and legs. This occurs due to DNA damage in the squamous cells which form the top layer of our skin.
It usually presents as a white, tan, pink, or brown scaly and crusty surface.
If it is not treated, it can turn into squamous cell carcinoma, a type of skin cancer, in about 5 to 10% of cases.
Diagnosis
Actinic keratosis is usually diagnosed clinically by a doctor. In some cases, they may do a skin biopsy to make sure it is not invasive squamous cell carcinoma.
For this, they take a small sample of skin and send it to a pathologist who examines the tissue under a microscope.
Treatment
Actinic keratosis can be treated by the use of medicated creams such as 5- fluorouracil, imiquimod, ingenol mebutate, or diclofenac. These topicals may lead to side effects like redness, burning, or discomfort.
Actinic keratosis can also be treated with cryotherapy, curettage, laser therapy, photodynamic therapy, or local excision.
10. Skin cancer
Rarely, a white bump on the face can be due to skin cancer, especially basal cell carcinoma.
Basal cell carcinoma is the most common type of skin cancer. Its origin is from basal cells which form the bottom layer of the epidermis. This cancer is usually seen on sun-exposed areas like the face, ears, neck, scalp, chest, shoulders, and back.
It can present in various ways:
- A non-healing ulcer
- A red or pink patch
- A shiny white, pink, or skin-colored bump
- A white scar-like patch or area
In some cases, it may be pigmented especially in people with darker skin tones, and can be confused with a mole.
Read more: Can Cancer Cause White Spots on Skin?
Diagnosis
It is usually diagnosed clinically by physical examination. A doctor may perform a skin biopsy in some cases to confirm the diagnosis.
Treatment
Treatment of basal cell carcinoma will depend on the type, location, and size of the lesion.
The common treatment modalities are:
- Surgical excision
- Mohs surgery
When surgery is not an option, the following treatments may be done:
- Laser therapy
- Cryotherapy
- Curettage
- Radiation therapy
To prevent this cancer, it is important to protect our skin from the damaging effects of the sun. Always use broad-spectrum sunscreen with SPF 30 and sun-protective clothing. In addition, avoid tanning beds.
Do not try to pop
Some of these bumps will go away on their own and some will require treatment. However, do not try to pop or squeeze white bumps at home as this can lead to the spread of infection or scarring.
If you need to get rid of them quickly, it’s best to see a doctor who can remove them by an appropriate procedure.
When to see a doctor
One should see a doctor if the white bumps:
- Appeared suddenly.
- Are growing in size.
- Involves multiple areas of the body.
- Is accompanied by fever or systemic symptoms.
- Are painful, bleeding, or have visible discharge.
- You are not sure what is causing them.
Key points
White bumps on the face are raised areas with white discoloration. Milia is one of the common causes of these bumps, however, white bumps on the face can also occur due to infections like folliculitis and Molluscum contagiosum, closed comedones, skin cysts, sebaceous hyperplasia, an allergic rash, and rarely actinic keratosis, and skin cancer.
While most of these are harmless, it’s best to see a doctor, if you are not sure what is causing them. Timely treatment of skin conditions like cancer can prevent serious complications.
Read more:
References
- Gallardo Avila PP, Mendez MD. Milia. [Updated 2022 Jul 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
- Schaffer JV, Berger EM. Molluscum Contagiosum. JAMA Dermatol. 2016;152(9):1072. doi:10.1001/jamadermatol.2016.2367.
- Olsen JR, Piguet V, Gallacher J, Francis NA. Molluscum contagiosum and associations with atopic eczema in children: a retrospective longitudinal study in primary care. Br J Gen Pract. 2016 Jan;66(642):e53-8. doi: 10.3399/bjgp15X688093. Epub 2015 Dec 6. PMID: 26639950; PMCID: PMC4684036.
- Basal Cell Carcinoma Treatment. Skin Cancer foundation.
- McDaniel B, Badri T, Steele RB. Basal Cell Carcinoma. [Updated 2021 Sep 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
- Zito PM, Scharf R. Epidermoid Cyst. [Updated 2022 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
- Winters RD, Mitchell M. Folliculitis. [Updated 2022 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
Disclaimer: This blog post is for information purposes only and does not replace medical advice.