Question

I am a 48-year-old healthy white female. For the last few years some scattered small bumps have been appearing across my entire face. They are small, of various size & shapes, and skin-toned. They look like tiny rocks or grains of sand beneath my skin. The old ones don't change, but don't go away, and more new ones are appearing. My family doctor prescribed the "pill" to help get rid of them, but there's no improvement after one year.

Answer

From your description, it is possible that you may have milia. Technically, milia are minute superficial keratinous cysts. These are an accumulation of sloughed cells that cannot escape through the top layer of skin, and so get trapped underneath and become firm, rather like pebbles under the skin, as you described. Their development is usually seen in people who have had significant sun damage, they can also be hereditary.

While they are harmless, people have milia removed for cosmetic reasons. This can be done reasonable well with chemical peels, microdermabrasion, or with laser resurfacing. Squeezing out the contents of each cyst individually through a tiny incision with a needle or a very small scalpel blade is another, more radical, approach.

You really need to consult a dermatologist who will be able to make an accurate diagnosis and assist you with treatment.

Although themselves harmless, milia may, rarely, be associated with the existence of more serious skin conditions.