Nipple inflammation is an infectious process of bacterial, fungal or viral nature that occurs in the area of the nipple-areolar complex. The main signs are pain and tightness in the nipple, hyperemia of the skin of the periarticular area, the appearance of liquid secretions (purulent, succulent or bloody) from the mammary glands. The diagnosis is established on the basis of complaints, physical examination data, laboratory and instrumental methods (ductography, ultrasound and radiography of the mammary glands). Treatment is conservative with the appointment of antibiotics and the treatment of the focus of inflammation with anti-inflammatory ointments.
General information
Inflammation of the nipple (telitis) rarely occurs in isolation, usually combined with areolitis (inflammation of the areola) or mastitis. Statistical data on the prevalence of pathology are unknown. Telitis is more often observed in breast-feeding women, but its development in men, newborns and non-lactating women is not excluded. As a rule, the infection of the nipple is attached a second time, against the background of other pathology of the mammary glands, hormonal or immune disorders. The occurrence of an inflammatory process is possible in one or both nipples. The urgency of the problem in mammology is due to the fact that an oncological disease – Paget’s cancer – may be hiding behind the telitis.
Causes of nipple inflammation
The disease is caused by pathogenic microflora that penetrates into the structures of the nipple through an epithelial defect or with blood flow from chronic foci of infection in the body. More often, the nipple is infected with Staphylococcus aureus and Streptococcus agalactia, less often with herpes virus, Candida fungi and other pathogens. Factors that activate the reproduction of pathogenic microorganisms include:
- Lactostasis. Stagnation of milk provokes the reproduction of opportunistic bacteria, which causes inflammation in the milk passages. Bacteria enter the nipple through the ducts and cause the development of inflammation. Lactostasis is promoted by flat or retracted nipples, in the presence of which there are difficulties with breastfeeding, and its incomplete emptying.
- Nipple cracks. They are often diagnosed in women in the postpartum period and in patients with increased dryness of the skin. Ulceration of cracks leads to the attachment of a secondary infection and inflammation of the nipple.
- Eczema of the nipple, allergic dermatitis. Accompanied by papular (with dermatitis) or vesicular-erythematous (with eczema) rash and intense itching. Combing rashes causes the formation of abrasions, wet erosions that become infected and inflamed.
- Intra-current pathology. With the development of intra-flow papilloma or the expansion of the milk passages, discharge of various types (with mucus or streaks of blood) appears from the nipple. Secretions serve as a breeding ground for bacteria, which activates their reproduction.
- Breast injury. Breast injury is accompanied by the formation of a hematoma and its subsequent suppuration with the penetration of infection into the tissues of the nipple. Also, inflammation of the nipple is promoted by its microtrauma (insect bites, scratches).
In women, benign breast tumors, hypothyroidism, the presence of inflammatory foci in the body, weakened immunity (transferred infectious diseases, hypothermia, stress) predispose to the development of the disease. In men, telitis and areolitis often accompany gynecomastia, the appearance of which is facilitated by hormonal disorders, taking anabolic drugs, obesity and diabetes mellitus.
Pathogenesis
The introduction of pathogenic microflora into the nipple can occur in two ways: through the damaged epithelium – exogenously and from the foci of chronic infection – endogenously. Microorganisms penetrate into the intercellular cracks, lymphatic vessels and then spread with the flow of lymph into the underlying tissues: smooth muscle layers, milk ducts, sebaceous and sweat glands. In response to the spread of pathogens, the body reacts with local and general symptoms. The local reaction is a change in blood circulation in the nipple: at first, arterial hyperemia occurs, later venous stasis develops, which leads to the formation of edema and blood clots, the occurrence of pain, local fever, the appearance of blood or purulent discharge from the nipple. The formation of the secretion is caused by the exudation of fluid into the intercellular space of the epithelium of the milky passages due to increased permeability of the vascular wall. The general reaction of the body is manifested by symptoms of intoxication and depends on the virulence of pathogens, the concentration of toxins and tissue breakdown products released by them, and the severity of immunity.
Symptoms of nipple inflammation
The intensity of clinical manifestations of the disease may vary depending on the etiological factor, the threshold of pain sensitivity and immunity. Palpation of the mammary gland allows you to determine the swelling of the nipple or a seal in the areola, soreness of the nipple-areolar region, swelling of the gland. The skin over the focus of inflammation is hyperemic, a sucreous, bloody or purulent secret is secreted from the milky ducts. Pain with telitis can be permanent or occur only when squeezing the nipple. The secret from the nipple can also be released continuously or only when it is compressed. Lactating women feel pain in the process of feeding the baby, excessive sensitivity and burning of the nipple. With the herpetic nature of the disease, in addition to the listed signs, vesicles with transparent contents and intense itching occur on the areola.
Intoxication syndrome includes a rise in temperature to febrile numbers, an increase in axillary, subclavian and cervical lymph nodes, fatigue, weakness and malaise, loss of appetite and other signs. With areolitis, the inflammatory process develops in the Montgomery glands, which is manifested by the swelling of one or more tubercles, their soreness and the release of a brownish or colorless secretion.
Complications
Untimely access to a doctor leads to complications. The infectious process can spread deep into the breast, which causes mastitis, phlegmon, and in advanced cases, gangrene of the breast. With the fungal nature of telitis, an infant can become infected with candida with the development of oral thrush. With prolonged secretion from the nipple, constant skin irritation, the occurrence of a malignant process is not excluded. Purulent inflammation of the areolar-nipple area ends with the formation of rough scars, deformation of the nipple and in some cases the entire breast.
Diagnostics
Diagnosis of nipple inflammation is not difficult and includes the collection of patient complaints, the study of anamnesis (connection with breastfeeding, the presence of endocrine pathology, diseases and injuries of the mammary glands in the past and now), examination, palpation of the breast and regional lymph nodes. To clarify the diagnosis, laboratory and instrumental methods of examination are carried out:
- Blood tests. In a clinical blood test, signs of inflammation are determined (leukocytosis with neutrophil shift, increased ESR). Biochemical analysis confirms the existing metabolic disorders and inflammation (increased liver enzymes, decreased total protein, increased sugar, the appearance of C-reactive protein).
- Research of hormones and cancer markers. In order to detect endocrine pathology, a blood test is prescribed for thyroid hormones, adrenal glands, sex hormones, prolactin. In case of suspected breast cancer, blood is examined for cancer markers (CA 15-3, CA 27-29).
- Examination of discharge from the nipple. When the secret is sown on nutrient media, the pathogen is identified and its sensitivity to antibiotics is determined. The study of the cytogram makes it possible to exclude the oncological process.
- Ductography. It involves the study of milk passages by introducing contrast into their lumen. It helps to identify a neoplasm (intra-flow papilloma) or expansion of the passages (ectasia of the milky ducts).
- Ultrasound of the mammary glands, mammography. They allow to assess the prevalence of the inflammatory process and diagnose incipient mastitis. Complement each other with the exclusion of benign and malignant formations of the mammary glands.
In order to identify the pathology contributing to the occurrence of telitis, related specialists are invited: an endocrinologist, a dermatologist. Inflammation of the nipple should be differentiated from Paget’s carcinoma.
Treatment of nipple inflammation
In uncomplicated cases of the disease, local conservative therapy is carried out. The nipple and areola are treated with antibacterial ointments, in the case of candidiasis of the nature of inflammation – with antifungal ointments, and with herpes infection – with antiviral ones. Pronounced symptoms of intoxication and purulent process indicate the addition of bacterial infection and require oral administration of broad-spectrum antibiotics (penicillins, cephalosporins, tetracyclines).
Lactating women with the formation of purulent foci in the nipple-areolar zone and the appearance of pus in milk, breastfeeding is prohibited, but regular pumping is necessary. To relieve pain, it is allowed to apply a cold compress to the inflammatory focus, which not only relieves pain, but also reduces signs of inflammation (swelling, hyperemia), and taking NSAIDs. When an abscess is formed, it is opened and drained. At the healing stage, ointments are prescribed that accelerate tissue regeneration.
Prognosis and prevention
With the elimination of etiological factors that cause inflammation of the nipple, the prognosis is favorable. The prevention of the disease during breastfeeding consists in observing the rules of breast care, preventing nipple cracks, and properly applying the baby to the breast. General prevention includes regular examination by a mammologist and elimination of diseases occurring with an erased clinical picture (intra-flow papilloma, ectasia of the milky passages), exclusion of contacts with allergens, correction of endocrine disorders, healthy nutrition, rejection of bad habits and strengthening of the body’s defenses.
