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

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Tuesday, February 14, 2012

What’s Making My Nipple Itch? Part II

By Jane Harrison-Hohner, RN, RNP

Now that we have reviewed the most, and least common, causes of itchy nipple(s), let’s see if one of these other skin conditions may be the culprit.

Contact Dermatitis

Most people are familiar with the type of contact dermatitis that may arise from poison oak/ivy, nickel earring posts, rubber/latex, or laundry products containing fragrance. These and other substances may trigger an itching of the skin, tenderness, and a variety of lesions (e.g., small blisters, red rashes) which can open to form crusting. Sometimes the skin reaction occurs after first contact, but in some cases repeated exposures over time are needed to induce the allergic reaction. When other causes have been ruled out a steroid cream/ointment, or tacrolimus, may be prescribed.

Seborrheic Dermatitis

Another common cause of itchy, inflamed skin is Seborrheic Dermatitis (SD). It particularly targets upper chest, back, scalp, and face where there is more sebum production. That is, SD is found where the skin is most oily. In addition to itching, there can be skin scales—flakey white or yellow in color. Between 11-12% of adults will have SD. The peak adult incidence is between the ages of 30 and 50.

The diagnosis of SD is based on the location of the lesions. Because it is a chronic condition, the person may give a history of having a similar outbreak in the same area.  SD tends to improve in the summertime. SD on the nipple can be treated with lotions containing selenium, ketoconazole, or corticosteroids. In a rigorous review of treatments for SD, ketoconazole was found to be the most effective, followed by another kind of antifungal, ciclopirox.

Candida

Most vaginal yeast infections are attributable to this type of fungus. Yet this is a less common cause of itchy nipple—except during breast feeding. In a study of 100 healthy breast feeding women between 2 and 9 weeks post partum, flaky or shiny skin accompanied by breast pain was the most likely to accurately predict a “yeast infection” of the nipple.

Diagnosis of candida of the nipple can be done with a skin scraping or a fungal culture. In a breastfeeding woman, itchy nipples may be treated presumptively (especially if the infant appears to have thrush in its mouth). During lactation nystatin-containing ointments or creams are used on the maternal nipples; the infant would receive an oral preparation of the nystatin.

Joggers’ Nipples

Irritation of sensitive nipple tissues can arise from rubbing of rough clothing or underclothes. Perhaps the most dramatic example of this is “joggers’ nipples”. In a report on dermatology injuries after running marathon races, between 3-16% of runners complained of nipple itching and irritation. Both men and women can be affected.

Neurodermatitis

Neurodermatitis is known by a variety of names including “itch scratch phenomena”. It starts with an irritation which could be eczema, atopic dermatitis, a fungal infection, or even rubbing by clothing. Chronic itching and scratching create a cycle of continued itching as nerve endings are stimulated. The result can be a roughened, thickened area of skin. While the extremities are common sites, it can also be found on the nipple—usually one side only. Neurodermatitis is more common among women, and is more prevalent between the ages of 30-50.

Diagnosis is made by ruling out other sources of itching. A skin biopsy might be done to confirm neurodermatitis if there has not been a response to other skin treatments. Since neurodermatitis can be exacerbated during times of stress and anxiety a person may be asked about their current stressors.

Given the variety of causes there are an assortment of treatments. Steroid ointments, or even steroids injected into the area to decrease inflammation might be prescribed. A 5% topical doxipen cream has had good results relieving itching. Tacrolimus ointment reversed the thickened, leathery skin caused by scratching. Successful alternative therapies have included TENS unit stimulators, and Chinese red hot needle therapy with cupping!

Self-help strategies encompass ways to stop the scratching to allow the skin to heal. The dermatologist may recommend occlusive dressings or bandages that both cover the skin from scratching and encourage medications to penetrate more deeply through thickened skin surfaces. One trigger for itching is dry skin, so avoiding long hot baths, minimizing soap use, and lubricating the skin while still damp may be helpful.

Before you feel crazed enough to “tear off” that itching nipple, my advice to you would be to see a healthcare provider to get an accurate diagnosis. Bear in mind that the culprit may be more than one condition, and that there are likely things you can do to decrease future problems. If you are interested in more information about either breast, or skin, problems, visit the WebMD Gynecology and Skin and Beauty communities or post your questions in the comments below.

Posted by: Jane Harrison-Hohner, RN, RNP at 12:35 pm

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