There’s a recent study on Nipple Eczema: An Indicative Manifestation on Atopic Dermatitis published in July 2014’s American Journal of Dermatopathology. The study of 43 individuals with nipple eczema, part of whom had eczema history and the others without eczema, showed no definite difference between the patterns of their nipple skin inflammation. It prompted me though to read further on nipple eczema, after all, it’s an issue close to women, plus breastfeeding mothers.
Nipple Eczema – is it Eczema?
Nipple eczema is often confused with Paget’s disease because of similar symptoms. Paget’s disease is a rare type of cancer at the nipple-areola complex (1-4% of female breast cancer). The confusion is that both have the appearance of eczema rash, possibly accompanied by itch, pain, tenderness, scales, cracks, oozing, nipple discharge/bleeding, redness and erosion. However, one distinguishing feature is that Paget’s disease affect the nipple first whereas nipple eczema affects the surrounding skin, i.e. the areola. It is also more likely to be unilateral than bilateral.
Nipple eczema can occur for both men and women, not limited to women who are breastfeeding/ pregnant.
Types of Nipple Eczema
Allergic contact dermatitis – If triggered by skincare product used on body, appearance of the rash would be on both breasts. A case study was reported in Indian Journal of Dermatology where topical application of ingredients like propylene glycol, chlorocresols and parabens trigger nipple eczema (though only on one breast).
Another study in June 2014 noted allergic contact to CI+Me-isothiazolinone, a chemical found in detergents, preservatives and fabric softeners. Thus possibly traces of CI+Me-isothiazolinone in undergarments triggered the eczema at the breasts.
Other possible chemicals that trigger nipple eczema could be protein allergens (food) from the baby’s mouth.
Atopic dermatitis (AD) – Due to the weaker eczema skin barrier and increased likelihood of sensitization to products, the risk of nipple eczema appears to increase with age for AD patients.
Irritant contact dermatitis – Chemicals, product ingredients and friction can irritate. Clothing may irritate or friction from exercise or from exercise bra/ disposable breast pad/ poor-designed nursing bra. There may be both irritant/allergic contact dermatitis to creams used on nipple during pregnancy/breastfeeding. Soaps, detergents, fragrance and bleach are possible irritants.
Yeast infection – This is more likely for women with history of yeast vaginitis or from babies who have thrush (i.e. yeast infection with white spots on baby’s tongue or mouth). The yeast infection will affect skin at the base of the nipple, with appearance of fine cracks. Yeast infection is reportedly more common after antibiotic use.
Bacterial infection – Eczema skin is prone to be colonized by staphylococcus aureus bacteria and the breast/nipple skin is not spared. Skin damage can lead to increased susceptibility for bacteria infection and the damage may come from scratching (on an AD patient) or certain activities during breastfeeding, such as use of uncomfortable breast pump, over-washing and cleaning of the nipple area which dries and damages the skin.
Diagnosis
Diagnosis is not easy as the symptoms look similar. Typically, ruling out Paget’s disease (esp if nipple eczema is only on one breast) is a priority. After which, patch testing can be taken to analyze which possible chemicals the patient has come into contact with that may possibly have triggered the rash.
What if Breastfeeding?
Nipple eczema can bring about soreness, pain and burning sensation, and prematurely terminate lactation and breastfeeding. Women who have eczema or sensitive skin may be more prone to nipple eczema. The breasts can be washed with lukewarm water and moisturized. Check with your doctor before applying cream on the breast/nipple to ensure safety for the baby. If prescribed cream, ask for clear instruction on wiping it off before breastfeeding. The liquid to wipe off the cream can be milk expressed from breast.
Anyone has experience on nipple eczema? Do comment and share. Breastfeeding does not come easy for many mothers (ME included!) and I can’t imagine piling on an itchy, painful nipple on top of the struggles. Do share and encourage another if you can!
16 replies on “Eczema News – Nipple Eczema – Types of Rash”
I’m following up with my derm in 3 week a but I want to see if anyone has come across the same issue. I was bf’ing my son for 3 years and 10 months. I have weaned my son 4-5 months ago and my right nipple would still cracked at the base where it meets the areola. I went to the nurse practitioner at the OB and she gave me some apno and the problem would go away when I apply the ointment but would come back when I stopped the ointment. Then I went to see a derm and he gave me some steroid cream and it would heal the cracked nipple but the problem appears again 3 days after I stopped applying the cream. I can see the area being moist as there are moisture coming out of the skin like sweat and it’s sticky to the touch. For some background, when I was bf’ing both of my breast irritated very bad and the same skin crack problem occurred and even irritated beyond the areola. The APNO helped a lot at the time and now all other areas are back to normal except one area of the skin folds at the nipple base. I was also put under diflucan for 7 days when I first suspected to have thrust but that didn’t clear up the skin issue then the APNO finally helped. Im now worried because I’m not sure why my nipple crack problem is still going after warning. Funny enough only the right side is having problem which is the side I used to bf the most. I’m seeing the derm again for a follow up in 3 weeks. Pray for me 🙁
Thanks for your sharing and have prayed for you, hugs. Hope it’d all get better soon!
Hello, I have itching, cracking and scaling in both nipples. I am still breast feeding for my one and half year old baby. So far I did not have these problems. But from December month I am having these. If I apply lanolyn cream then no issue. If I don’t apply and keep the nipple dry, then it’s getting cracked. In Suspect this is due to weather as I am having dry skin. Any ideas would be appreciated. This is my first winter here.
My one and half year old has eczema in December. So can this be a cause too
Sorry to hear of the problems.. could be many reasons too, especially with baby’s saliva, frequent cleaning which more easily results in dryness.. will storing breast milk helps? Can also try soaking bath tub mixed with emollient? Take care!
Hello! My 5 months baby currently has severe eczema on her right nipple. The doctor has prescribed an antibiotic cream but it hasn’t cleared out yet (it’s been almost a week)! It’s red, inflamed, dry/scaly, and literally 4 times bigger compared to her left nipple.
Aside from applying the antibiotic cream, I’m honestly not sure where to begin – changing laundry detergent? Reflecting on my diet as I’m exclusively breastfeeding? Avoid using any Aveeno baby eczema body wash cream on the nipple area?
Any thoughts or suggestions??
Hi Shirley,
So so sorry to hear of the severe eczema at the nipple area for your 5-month old baby.. it’s not common to be at the nipple area, and from my years of moderating eczema forums and support group, I haven’t heard of anyone having baby nipple eczema. Suggest that you bring your baby to see a pediatric dermatologist.. if a cream hasn’t worked after first few days, it may not be the right cream. Prescribing cream always take some trial and error, hope that you find the right treatment for her. Please don’t worry about breastfeeding etc, if the eczema is only at one targeted spot, it’s unlikely to be food related..
Take care, hugs,
Mei
Hi! I am 17 years old, soon to be 18, I just noticed some flaking skin on my left areola, though I don’t feel any pain or itching. I am just very concered. Its very cold where I am currently . Should I be worried or visit a doctor right away? Also, what are the chances I could get breast cancer being a teen?
Hi! I do think you should visit a doctor if you’re worried – the symptoms of Paget disease of the breast is very similar to eczema, and you should see doctor to get a proper diagnosis. While breast cancer is not that common for teen, I read that there’s report for Paget disease as well.. see the below links? take care!
https://www.cancer.gov/types/breast/paget-breast-fact-sheet
https://www.healthcentral.com/article/nipple-issues-when-to-worry-when-to-wait
Hi Shirley, I know your comment was a while ago but my 4 month old daughter has the same problem. Her nipples get better and then flare up again and ooze. I keep changing creams/ointment/laundry to jo avail. What was the outcome for your little one?
Hi Jess,
Thanks for dropping by; I’ve dropped an email to Shirley to ask her to check this post and see if she can help. As the comment was some time ago, I’m not sure if she is still checking the email or this blog. Hope things get better for your daughter.. take care, hugs.
Hi Jess,
(Thanks Mei for reaching out)
My daughter is now 15 months and her nipple eczema finally calmed down around 12months. We did end up seeing a dermatologist and she recommended us to continue applying the hydrocortisone (steroid) cream until the red and flare ups subsided for a few days. My daughter’s nipple is currently still discolored but my doctor said it’s simply the eczema and not the steroid cream itself. I still put on aveeno eczema cream daily for her and on top of the steroid too when it flares up as it also requires moisturizing to keep it from flaking. It takes time and I guess the little ones do end up growing out of it eventually. Hang in there!
Thank you Shirley! Glad to hear your daughter is much better!!
Thanks for sharing and it is reassuring and very glad to know that our little ones do get better 🙂 Thanks again!
I am glad I don’t have this. Actually I have no Eczema at all, but my son does mostly on his knees, ankles, elbos, and wrists. His SD isn’t involved in his life but he had patches on his face we are pretty sure is eczema so he probably got the susceptibility to it from him, but my ex never had it diagnosed. My son also used to get it on his face, but fortunately almost never does anymore. Glad I don’t have it and glad it’s not on the nipples for sure! That’d drive me crazy!
Hi Amanda!
Thanks for dropping by and yes, thankfully kids with mild eczema have a better chance of outgrowing eczema 🙂
Take care and moisturize during winter!
Mei