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Author: Siska Falconer, Medical Student, Auckland University, Auckland, New Zealand. DermNet NZ Editor in Chief: Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Gus Mitchell. January 2020.
Hyperkeratosis of the nipple and areola describes verrucous thickening of the nipples and areolae [1–5]. It can be primary (idiopathic) or secondary to another disorder (see differential diagnosis).
Hyperkeratosis of the nipple and areola is also called naevoid hyperkeratosis and hyperkeratosis areolae mammae naeviformis.
Hyperkeratosis of the nipple and areola
Primary hyperkeratosis of the nipple typically presents in adolescent females, with the rates in males being much lower [1,2,4]. No ethnic or geographical links have been reported.
The exact cause of hyperkeratosis of the nipple is not known. Although no hormonal alterations have been found, an endocrinological cause has been proposed due to its association with the female sex, oestrogen therapy, and pregnancy .
The clinical features associated with hyperkeratosis of the nipple follow.
Hyperkeratosis of the nipple may cause embarrassment and cosmetic concerns . There are a few reported cases of difficulty breast-feeding from the affected breast .
Diagnosis of hyperkeratosis of the nipple relies upon the clinical presentation of the hyperkeratotic plaque(s) and findings on skin biopsy if the presentation is atypical.
Histopathological characteristics of hyperkeratosis of the nipple are:
Secondary hyperkeratosis of the nipple [1,2,5] is usually unilateral. Examples include:
Unilateral hyperkeratosis of the nipple associated with pain, bleeding, ulceration, discharge, or nipple retraction should be investigated with breast examination, mammogram, and biopsy, in case of breast cancer.
Bilateral secondary hyperkeratosis of the nipple and areola may occur with:
Untreated hyperkeratosis of the nipple does not tend to interfere with the normal breast function. However, treatment of the lesion is generally warranted for cosmetic reasons [4,5].
Cryotherapy is a suitable first-line treatment for hyperkeratosis of the nipple often gives a cosmetically satisfactory result [4,5]. It may need to be repeated. Hypopigmentation is the main long-term risk of cryotherapy.
Without treatment, hyperkeratosis of the nipple persists.
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