What are those little white bumps on my face…?

As I stepped up on to the therapist’s bed I was already starting to relax. She gently covered me with a blanket, secured my hair away from my face and started with an essential oil ritual. I began to feel calm, serene, relaxed… After cleansing, she rolled the steamer over and left me to my thoughts while my pores slowly opened. After 5 minutes she rolled the steamer to the side and turned on the bright light. And that’s when she gasped…  

I don’t know if this has ever happened to you. It happens to me a lot.  It’s the moment when the therapist realises how bad my skin actually is. I don’t know if its anxiety or excitement that causes the gasp – some of them love the thought of the extractions to come. Personally, it’s something that quickly takes me from the initial calm headspace I’m in, and puts me right back into my usual self-conscious state. I like to think I’m used to this reaction. But as I get older I am getting more annoyed that this is still the story of my skin. I wish I could have left this all behind with the other teenage woes...

Thanks to my mom’s early interventions and teachings I have always had a good grasp of what works for my skin. I know when to use which type of mask, the importance of exfoliating, going for regular facials and most importantly - when to know that you need professional help. I’ve seen countless dermatologists and every time I have to carefully explain to them – no I am not making this up, this is my skin history, it runs in my family, and then I have to almost beg them to fix me... Most of them don’t believe me and just think I like to exaggerate to get the medications I know will work for me. At least that’s how it feels when I’m in their clinic…  
Through all of this though, I have noticed that as much time and effort as I spend preventing, I still get new bumps on my skin. I have tried having them lanced out (when they make a small nick in your skin and take them out), I’ve tried extractions during a facial, I’ve tried exfoliants, I’ve tried clay masks, I’ve tried lasers, I’ve even taken prescription medication… All of these do work. The problem for me is that they only work for a little while. Sometimes its months, or even (if I’m lucky) a year or more, but mostly it’s only a few weeks.  
In order to understand these things for yourself, you need to understand that differences in the types of “lumps and bumps” on your skin:
  1. Closed comedones (“whiteheads”) are caused by a blocked pore and often appear as white bumps on the skin:

(http://www.clearskinstudy.com/what-are-comedones-and-why-do-i-get-them/ )
  1. Open comedones ("black heads”) are when the blocked pore is open and the surface appears black from melanin (not dirt as commonly thought):

(http://www.dermnetnz.org/acne/comedonal-acne.html ) These can be limited on the skin and may only appear at certain times – teenage years, hormonal cycles – or they can proliferate and even become inflamed and infected. At this point you may be diagnosed with comedonal acne. And this is exactly my diagnosis – however mine is limited to closed comedones (I do have the occasional open comedone on my nose, but nothing too scary).
There is a third term that you may hear occasionally related to these “lumps and bumps” on your skin:

3. Milia are often confused with closed comedones as they look alike.

On physical appearance though the milia are often a harder round lump, and the close comedone may be a little softer and not as hard and round. You’ll know the difference if you squeeze – milia comes out as a perfectly formed, round hard white ball. And closed comedones come out in a white greasy thread. Note that there are many types of milia – you can read up on them here http://www.dermnetnz.org/lesions/milium.html .
Essentially I have discovered that I have a problem that is 2 fold – I have both milia and closed comedones.
And I am happy to say that the treatments for both do have some common characteristics:  
Characteristics & Causes:
  Milia Closed Comedones
Characteristics ·  Small cyst containing keratin ·  Appears as hard round white/ pearly lump ·  Often around eyes, eyelids, mouth, nose, behind the ears, along the jaw, cheeks and forehead ·  Forms at the site of a hair follicle ·  Can resolve on its own and doesn’t always require intervention · Caused by blockage of the follicle either by dirt and debris or sebum · Can occur almost anywhere but rarely on the eyelids · Forms at the site of a hair follicle · Soft white lump · Requires intervention  
Causes ·  No specific cause but generally occurs at the site of injury during healing (burns, scalds, skin resurfacing (e.g. dermabrasion), long term use of steroid creams) · Hormonal changes · Reduced linoleate in sebum (this is the salt of the essential fatty acid, linoleic acid) · Increased inflammatory proteins · Free fatty acids produced by bacteria · Overhydrated skin (moisturisers or humidity) · Follicle damage or rupture (abrasive cleansing, chemical peels or laser treatments) · Chemicals such as: Oily pomades, isopropyl myristate, propylene glycol, and some cosmetic dyes · Smoking · Dietary factors – milk and high glycaemic index foods (sugars and fats)
  Milia Treatment Closed Comedone Treatment
Similar ·   Topical retinoids  (e.g. retinA) ·   Oral retinoids (e.g. roaccutane or Accutane (isotretinoin)) ·   Chemical peels (usually done in a doctors clinic) ·   Dermabrasion (also microdermabrasion) ·   Laser abalation (usually done in a doctors clinic) ·   Tetracycline antibiotics (e.g. minocycline) ·   Extractions (e.g. using sterile needles with physical squeezing, usually performed by a doctor or professional therapist)
Different · Cryotherapy · Diathermy and curretage   · Hormonal therapy (e.g. contraceptive pill) · Benzoyl peroxide (e.g. Clearasil, proactiv) · At home use acids: Azelaic acid, salicylic acid, glycolic acid · Prescription antibiotic creams
(http://www.dermnetnz.org/lesions/milium.html ) (http://www.dermnetnz.org/acne/comedonal-acne.html ) (http://www.healthline.com/health/milia#Causes2 )  
With the understanding I’ve gained over years of doctors’ visits, therapists advice, reading everything I could, researching the ingredients in my skin care, I have gained a semblance of control. I know that I need to control both the internal and the external factors that lead to both my milia and my closed comedones. Of course, real life always gets in the way – who always has the time to do a mask (or remembers every day/ week), who has the endless resources to pay for professional treatment, who has the time for a facial every 2-3 weeks, and who among us has never eaten anything sinful? That is my ideal – but it’s not realistic. If this is you – and you have the time and resources – I say good for you! Go out there and show off your beautiful skin - you deserve it. As for the rest of us, we will continue our quest to find the perfect balance for our skin.  
I hope that this blog has helped you understand your skin a bit better, and what changes you can make to improve it.
Jené Roestorf,
Global Ingredient Hunter

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