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 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!