Usually, providers can diagnose eczema by looking at your skin. Your provider will ask about your symptoms and examine the skin around your nipples. They will also look for signs of eczema on other parts of your body.
Breast eczema (atopic dermatitis) is a condition that causes your skin to become dry, discolored, itchy and bumpy. It may appear in the dark areas around your nipples (areolas), between your breasts, under your breasts, on the sides of your breasts or elsewhere on your chest.
Paget's disease usually affects the skin of one nipple and produces eczema-like symptoms, appearing as an itchy, red rash on the nipple that can extend to the darker area of surrounding skin (the areola).
This condition develops in the nipple or the darker area of skin around it (the areola). It usually first appears as a red, scaly rash of the skin that may look like eczema. There might also be some discharge or bleeding from the nipple.
There is a type of breast cancer called inflammatory breast cancer that can cause skin changes on your breast. With this type of cancer, the breast or part of the breast can become red, inflamed, painful and swollen.
Breast cancer can cause changes and inflammation in skin cells that can lead to texture changes. Examples of these texture changes include scaly skin around the nipple and areola, as though the skin is sunburned or extremely dry, and skin thickening in any part of the breast.
Breast-feeding women often have trouble with nipple dermatitis; many have a prior history of eczema (atopic dermatitis) or easily irritated skin. Breast-feeding women with a previous history of yeast vaginitis or whose infants also use a bottle or pacifier may have more risk for a yeast nipple infection.
Men and non-breast-feeding women who have nipple dermatitis also often have a history of eczema or easily irritated skin. Asymmetric breast size may lead to irritation from clothing or friction from exercise.
Malignant cells known as Paget cells are a telltale sign of Paget disease of the breast. These cells are found in the epidermis (surface layer) of the skin of the nipple and the areola. Paget cells often have a large, round appearance under a microscope; they may be found as single cells or as small groups of cells within the epidermis.
Doctors do not fully understand what causes Paget disease of the breast. The most widely accepted theory is that cancer cells from a tumor inside the breast travel through the milk ducts to the nipple and areola. This would explain why Paget disease of the breast and tumors inside the same breast are almost always found together (1, 3).
A second theory is that cells in the nipple or areola become cancerous on their own (1, 3). This would explain why a few people develop Paget disease of the breast without having a tumor inside the same breast. Moreover, it may be possible for Paget disease of the breast and tumors inside the same breast to develop independently (1).
Because the early symptoms of Paget disease of the breast may suggest a benign skin condition, and because the disease is rare, it may be misdiagnosed at first. People with Paget disease of the breast have often had symptoms for several months before being correctly diagnosed.
For many years, mastectomy, with or without the removal of lymph nodes under the arm on the same side of chest (known as axillary lymph node dissection), was regarded as the standard surgery for Paget disease of the breast (3, 4). This type of surgery was done because patients with Paget disease of the breast were almost always found to have one or more tumors inside the same breast. Even if only one tumor was present, that tumor could be located several centimeters away from the nipple and areola and would not be removed by surgery on the nipple and areola alone (1, 3, 4).
At a follow-up visit 3 days later, she had had no improvement, so twice-daily clotrimazole cream, 1%, was added to her regimen, and she was advised to not wear a bra and to use soap for sensitive skin.
Clinical course. She returned to the clinic 4 days later and reported that her symptoms had improved somewhat. Topical mupirocin was added to her regimen to penetrate the nipple, areola, and surrounding skin. At a scheduled follow-up visit 1 week later, the lesions had improved significantly, and she was advised to continue taking mupirocin, using gentle soap, and not wearing a bra.
Nevertheless, after another week had passed, she returned to the clinic with worsening symptoms. On physical examination, the bilateral rash on her breasts had reverted to a presentation similar to that seen at her initial visit, with both areolas demonstrating hyperpigmentation, inflammation, scaliness, and a surrounding erythematous patch. Pain had again developed in the right breast.
Studies have supported the concept that interactions between dendritic cells, T cells, keratinocytes, neutrophils, and the cytokines released from immune cells likely contribute to the initiation and continuous nature of the hallmark skin inflammation of psoriasis.5
Psoriasis signs and symptoms can vary from person to person but may include one or more of the following: red patches of skin covered with silvery scales; small scaling spots (more common in children); dry, cracked skin that may bleed; pruritus, burning, or soreness; thickened, pitted, or ridged nails; and swollen and stiff joints.6 The typical plaque psoriasis pattern is bilateral, symmetric, and usually encompasses areas of the body that are not exposed to sunlight.7
Topical corticosteroids are the primary treatment option for plaque psoriasis in patients who have limited skin involvement. Skin atrophy, hypopigmentation, and striae can develop with the use of topical corticosteroids. Moreover, the clinical response tends to diminish over time.
Emollients such as petrolatum, as well as occlusive dressings and a topical vitamin D compound such as calcipotriene ointment, 0.005% twice daily, can be added to the treatment regimen to maintain hydration and minimize pruritus.4 Patients with moderate to severe plaque psoriasis (ie, psoriasis involving more than 5% to 10% of the skin) usually require an alternative approach such as phototherapy or any of a variety of other systemic medications.8
There are different views about swabbing. Some breastfeeding organisations recommend swabbing to confirm thrush1. However, some studies say that swabbing is neither reliable nor accurate, as Candida can be part of the normal healthy skin surface. Although the Candida species can be easily singled out in the laboratory when present in milk, there is a lack of consistent rules for milk sample, collection, storage and analysis globally. 2
Skin conditions, such as eczema or psoriasis, can affect the nipple area. Some people may also have sensitivities to nipple balms containing lanolin. If you have a history of skin allergies or a similar problem elsewhere on your body, discuss this with your GP. A dermatology referral is sometimes necessary.
Others believe that since thrush does not grow on normal skin, damage of the nipple and areola as a result of a shallow latch is the real problem and that, unless this is dealt with, nipple thrush will remain difficult to treat. 13
Skin conditions such as eczema or dermatitis may occur on the nipple and the areola, the flat coloured part around the nipple. These problems are more common in women who tend to be allergic (eg. have known eczema, asthma or hay-fever), or who are pregnant or breastfeeding. Irritant contact dermatitis is caused by inflammation of the skin by products such as shampoos, soap, washing detergents or chemicals. Allergic contact dermatitis is a true allergy to a product used on the skin.
With any of these causes, a rash is seen on the nipple or areola which may be dry or weepy. The rash is usually itchy and may be on one or both breasts. There may be an associated burning pain especially if breastfeeding. In breastfeeding women the symptoms often occur around the time of infant teething or the introduction of solids.
Eczema or dermatitis may cause weeping and crusting on the nipple. However, if at any stage you see true nipple discharge coming out of a single duct on the nipple, or if the skin changes on your nipple do not get better with the above treatment, please return to Sydney Breast Clinic for prompt review as this may indicate a different condition.
It is very normal to experience dry nipples even early on during your pregnancy. As the pregnancy hormones settle in, there can be a whole host of changes going on in your body, (some more fun than others!) including dry and sometimes flaky skin on and around the breasts and nipples.
As the breasts get ready to produce all that wonderful milk for your baby, they swell and grow. This leads to stretched skin which can at times become thinner and dry as a result of the excess growth.
As with any dry skin issues, keeping yourself well hydrated is one of the key things you can do to help. Drinking 2-3 litres of water per day helps to keep you and your skin well hydrated and supple.
If you are already producing colostrum you could also express a few droplets of this wonderful golden milk and rub that into the nipples. Colostrum has incredible antibacterial and soothing properties and can really help with dry cracked skin. You can leave the breasts to air dry after application. This can also help if you have any issues with cracked nipples when breastfeeding.
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