Nipple eczema: everything you need to know

They are among the most erogenous, highly sensitive areas of the human body. No wonder that dermatoses on the nipples can be extremely painful and unpleasant.

Key information about the nipple region:

• It consists of the nipple (mamilla) and areola.
• As a secondary sexual organ, it fulfils important sexual and aesthetic purposes as well as physiological ones.
• The nipple-areola complex is heavily pigmented and contains openings of the milk ducts and various glands.
• While the area is spared from certain skin diseases, it is favoured by others.

What types of nipple eczema are there?

The classic type is nipple eczema in breastfeeding women. However, it is also not uncommon for athletes to suffer from irritated nipples due to the combination of sweat, heat and chafing clothing. This phenomenon is also known as jogger's nipples.

These frequent nipple dermatoses are typical forms of contact dermatitis. It is caused by irritating substances that come into contact with the nipple and have a cytotoxic effect. A distinction must be made between allergic and atopic nipple eczema. The latter affects around 6-23% of patients with atopic eczema, most frequently young women. Both nipples, including the neighbouring breast, are usually affected.

Finally, allergic contact dermatitis is a type IV hypersensitivity reaction in which an allergic reaction is triggered after primary sensitisation. Possible allergens are components of clothing such as dyes or adhesives, residues of detergents or fabric softeners, but also metals in nipple piercings or colours of tattoos.

All three forms can lead to painful, burning or itchy sensations. Clinically, redness, erosions, crusts, fissures, scaling and lichenification are often seen. However, differentiation from other dermatoses can be difficult. In addition to inflammatory and infectious skin diseases, malignant changes should also be considered in the differential diagnosis and should not be overlooked. For example, retractions of the nipples or palpable subcutaneous masses may indicate Paget's disease. If in doubt, a biopsy should be performed. If an infectious origin is suspected, a smear test will help, and in the case of allergies, appropriate skin tests are recommended.

How is a nipple eczema treated?

As a general rule, provoking factors such as irritants, allergens and repeated friction should be avoided. Athletes should use well-fitting tops and sports bras, protective bandages or Vaseline on the nipples can also help.

When breastfeeding, adjusting the baby's position can be useful. Compresses with black tea and ointments containing tannin can relieve the pain. After breastfeeding, the nipples should always be gently cleaned with lukewarm water and dried in the air.

If necessary, anti-inflammatory topicals are used for treatment. Class II or III corticosteroids and calcineurin inhibitors, both of which are also considered safe during breastfeeding, are tried and tested. In the case of a secondary infection, appropriate antibiotics or antimycotics are indicated, which are administered locally or systemically depending on the extent of the infection.

Key take-away for medical practice

Eczema in the sensitive nipple area can cause a great deal of discomfort and even tempt young mothers to stop breastfeeding prematurely. To prevent this from happening, the symptoms should be alleviated as quickly and comprehensively as possible.