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with Jane Harrison-Hohner, RN, RNP and Laura Corio, MD

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Monday, February 6, 2012

What’s Making My Nipple Itch Like Crazy, and What Should I Do?

By Jane Harrison-Hohner, RN, RNP

“Driving me crazy!” “I want to tear my nipple off!” These are just a couple ways our readers have described the torment of a nipple itch. Both women and men have written to WebMD about this frustrating condition, most often with vivid descriptions of their itching agony. Yet rarely is there a documented diagnosis and treatment. The causes can include one breast and numerous skin conditions. To give you the best overview I have decided to cover the most worrisome and most common causes first, to be followed by some of the other origins of an itchy nipple.

Paget’s Disease

Paget’s Disease (PD) is a rare form of breast cancer that can involve both the nipple and the aerola (colored area that encircles the raised nipple). While it’s the least common cause of nipple symptoms, it is the most worrisome. So let’s discuss it first.

An itching or burning sensation of the nipple or aerola is a common initial symptom; it is often accompanied by a crusted appearance. Persisting soreness/itching with a scaly, eczema-like rash that does not improve despite prescription treatment is highly suspicious for Paget’s.One may also have a yellow- or blood-tinged nipple discharge from the affected side. In later stages there can be an ulcer or mass in the areola. Most often, PD involves only one breast. Thus it is not usually linked to bilateral nipple itching or rashes. PD is typically found in women between the ages of 50 and 60.

PD is diagnosed with a clinical breast exam, thorough patient history, mammogram, and an ultrasound if indicated. If there is still a suspicion, despite a normal exam and mammogram, a MRI can be utilized to identify PD. A breast biopsy of the nipple will provide tissue to be sent to pathology for a microscopic examination and conclusive diagnosis. Any coexisting lumps would be biopsied as well.

Even though you have an itchy, crusted nipple with a discharge there is a benign (non-cancerous) condition which can mimic PD. One can have a benign tumor of the breast duct tissue called “erosive adenomatosis of the nipple”. This is why a surgical biopsy is the “gold standard” for conclusively diagnosing PD.

Treatment for Paget’s disease is breast surgery, either mastectomy or a cone-shaped excision of the nipple. One study from Sweden followed women for 12 years to see if mastectomy was necessary for all women with PD. Those who just had Paget’s of the nipple (not invasive breast cancer) were selected for the cone-shaped excision. Those select patients with the breast conserving surgery had survival rates similar to those who were treated with mastectomy.

Atopic Dermatitis

From the least common cause of itchy nipple (Pagets’s Disease), let’s move to the other end of the spectrum and discuss one of the most common causes. That would be Atopic Dermatitis (AD), also known as eczema. With this condition itching is almost always present and can be severe. Itching may even precede the development of an overt rash. The rash can include small blisters with oozing or crusting. Further scratching could open the skin to bacterial infections or create thickened areas from constant inflammation and irritation.

Atopic Dermatitis can appear in persons of all ages. Since AD is thought to be due to a hypersensitivity reaction, persons may be more prone to develop AD if there is a personal or family history of allergies (e.g., asthma, hay fever).

Environmental triggers which can prompt AD to flare up can include:

  • Dry skin
  • Prolonged contact with water
  • Dyes or scents added to skin products
  • Environmental allergens such as cleaning products, wool, foam
  • Stress

Atopic Dermatis is usually diagnosed by physical exam and a thorough history. If needed a skin biopsy can be done to rule out other causes of the itching and rash. When itching is severe and/or there is a known allergic trigger, antihistamine pills can be helpful. These would include both the sedating type (e.g., Benedryl®), or the non-sedating type (e.g., Clartin® or Zyrtec®).

The majority of AD remedies are topical treatments. One might be prescribed a steroid cream or ointment. A newer class of medications includes the topical immune modulators (e.g., tacrolimus or pimecrolimus).

There are also self-care and preventative strategies, which can decrease AD symptoms. Avoiding known triggers is foremost, but keeping natural moisture in the skin is an important goal. This can be achieved by decreasing use of drying soaps and prolonged hot baths. Once out of the bath or shower, a bland ointment or cream can be used to seal moisture in.

Interestingly, a number of our readers suggested treatments which fit this description. NipStick®, designed for joggers’ nipples, contains shea butter, jojoba oil, and beeswax. Another reader successfully used Kiss My Face Lip Balm® containing canola oil, beeswax, lecithin, coconut oil, and other emollients on her itchy nipples. Even Eucerin Aquaphor was found to be helpful by a reader.

Check back next week for other conditions that might be causing your itching.

Have a problem you’d like to discuss? Join Jane Harrison-Hohner in our Women’s Health community.

Posted by: Jane Harrison-Hohner, RN, RNP at 3:30 pm

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