Eczema on nipple is an allergic dermatosis, manifested by an erythematous vesicular rash in the area of the nipples and adjacent alveoli. Rashes are accompanied by itching, painful sensations, dryness and peeling of the skin. When making a diagnosis, examination data, tests to determine the level of immunoglobulins and histamine, the results of microbiological examination of nipple scraping are used. In the course of treatment, antihistamines, anti-inflammatory, sedatives, immunocorrective, antimicrobial drugs are used in combination with physiotherapy techniques and diet correction.
Usually eczema on nipple develops as a post-traumatic complication of lactation in women predisposed to allergic type reactions. According to research, in more than half of cases, the disease occurs against the background of active reproduction of opportunistic flora (staphylococci, candida, etc.), the accumulation of waste products of which creates a favorable environment for inflammatory and allergic reactions. Therefore, most specialists in the field of clinical mammology and allergology consider this variant of dermatosis to be one of the types of microbial eczema. The disease is prone to recurrence.
Eczematous lesion of the nipple-areolar complex in women usually occurs during breastfeeding against the background of skin traumatization. This is caused by a combination during lactation of three key factors contributing to the appearance of eczema — a local inflammatory reaction, hereditary predisposition and neurohumoral changes. Predisposing factors include:
- Skin injuries during feeding. At the beginning of lactation, when there is not enough milk in the mammary glands, the child makes considerable efforts to suck out colostrum. The nipple-areolar zone is subjected to traumatic stress, provoking inflammatory infiltration with subsequent cracking of the skin, which becomes the initial stage of eczema.
- Tendency to allergic reactions. In the anamnesis, such patients most often already had other manifestations of allergies. In laboratory studies, characteristic changes in the blood of patients are detected in the form of an increased content of one of the fractions of immunoglobulins — IgE. Usually, this type of response is genetically determined.
- Stress. In the first days of child care, the way of life of a woman radically changes. An increase in the tone of the sympathetic nervous system provokes the release of histamine, which increases the inflammatory reaction in the nipple area. Insufficient secretion of glucocorticoids, characteristic of patients with an allergic predisposition, leads to a prolonged course of inflammation.
Additional factors contributing to the development of eczema on nipple are nutritional errors (eating red vegetables and fruits, citrus fruits, chocolate, smoked meats), colds and infectious diseases that weaken the immune system, the use of low-quality household chemicals, wearing synthetic underwear. The risk of damage to the skin of the areola and nipple increases when feeding a baby with a short tongue frenulum.
The key link in the mechanism of the eczematous reaction is the immuno-inflammatory processes that occur in the lesion. Mechanical effects on the skin of the nipple, provoking the release of inflammatory mediators, lead to spongiosis — edema of the tissues of the thorny layer of the epidermis. Against the background of inflammation of the papillary layer, vessels expand, parakeratosis develops – the inability of epidermal cells to synthesize keratogyalin disrupts the processes of keratinization, while characteristic rashes appear on the skin. A significant number of lymphocytes accumulate in the affected areas, which is accompanied by infiltrative processes and acanthosis (hyperpigmentation) of the nipples.
The disease usually manifests itself in the first weeks of breastfeeding. At first, the woman experiences itching in the nipples and the surrounding areoles, subsequently the skin in the nipple-areolar zone becomes crimson, small bubbles and small-point erosions appear on it, which is accompanied by wetness. Often the lesions have clear boundaries. Dried areas are covered with crusts and scales, which gradually peel off. The peeling period can be quite long. In the affected areas of the skin, pain of varying intensity occurs, which increases during feeding. One of the most characteristic symptoms is increased itching at night.
During the transition of the disease to the subacute and chronic stages, signs of dryness and thinning of the skin prevail, the presence of point erosions in the areolar region, many small cracks and peeling. Itching is usually mild or absent. There is no Moknutia. Against the background of diet errors and weakened immunity due to colds or stress, periods of exacerbations are possible, during which a typical clinical picture of the acute phase develops. The secondary infection that has joined is indicated by the spread of the inflammatory process beyond the areoles and the appearance of yellowish crusts.
Intense itching, characteristic of the acute phase and periods of exacerbations, affects the emotional state of a woman. The patient becomes irritable, tearful, often she has a depressed mood. Since itching increases at night, the situation is aggravated by chronic lack of sleep. Sometimes eczema on nipple is complicated by a secondary bacterial skin infection or mastitis with the appearance of general toxic symptoms in the form of an increase in body temperature, chills, weakness, fatigue, decreased or lack of appetite and local symptoms (purulent rashes, breast compaction, etc.). The long-term consequences of pathology are small pale spots in the areola area that occur at the site of eczematous rashes.
With classical clinical manifestations, diagnosis is not particularly difficult. Difficulties in diagnosing eczema on nipple are usually associated with an erased course or atypical symptoms, which happens extremely rarely. An important task of the diagnostic stage is to exclude secondary infection. The following research methods are the most informative:
- Microscopy and seeding of scraping. With the microbial nature of eczema, microorganisms that contributed to the development of the disease are determined in the discharge from the lesion.
- The level of immunoglobulins. Patients with an eczematous reaction usually have an increased level of IgE as a marker of allergic reactions, and such changes are observed even outside of exacerbation.
- The level of histamine in the blood. As with other forms of allergic dermatoses, with eczema on nipple, the concentration of histamine in the blood increases, which is involved in local and general reactions.
In doubtful cases, with a prolonged course, cytological examination of the separated nipple or biopsy from the affected area, ultrasound of the mammary glands and mammography, allergological testing is shown. Differential diagnosis is carried out with nipple cracks, herpetic rashes, infectious inflammation of the skin in the areola area, Paget cancer. If necessary, the patient is consulted by an allergist, dermatologist, infectious disease specialist, oncologist.
Eczema on nipple treatment
Medical tactics are aimed at relieving the clinical manifestations of the disease and achieving stable remission by eliminating the prerequisites that contribute to the occurrence of pathology. To achieve results more quickly, complex drug therapy is supplemented with physiotherapy procedures and a special hypoallergenic diet. The treatment regimen includes the following groups of medicines:
- Antihistamines. Since the mechanism of eczema development is based on the pathogenesis of an allergic reaction, inhibition of histamine secretion can reduce the severity of itching, exudation. Due to the impact on one of the key links of allergy, it is possible to stabilize local inflammation faster.
- Anti-inflammatory drugs. Usually, the administration of nonsteroidal anti-inflammatory drugs is sufficient to suppress the secretion of inflammatory mediators and increase the threshold of pain sensitivity. In more persistent cases of the disease, the use of glucocorticosteroids is justified.
- Sedatives. To correct emotional disorders and sleep disorders, which are often complicated by eczema, herbal preparations with a sedative effect are prescribed. It is extremely rare to use more powerful drugs from the groups of tranquilizers and antidepressants.
Basic therapy, if necessary, is supplemented with immunocorrectors that allow normalizing the immune response, antibacterial and antimycotic drugs that affect pathogenic and conditionally pathogenic flora, which contributes to the maintenance of inflammation. In complex clinical cases, in addition to tablet forms and ointments, parenteral administration of drugs is prescribed. Electrophoresis, ultraphonophoresis, laser therapy, UHF, UVI, diadynamic currents are used to relieve acute symptoms of eczema.
When continuing breastfeeding, it is recommended to strictly observe the regime. The intervals between feedings should be at least 2.5-3 hours. At this time, it is advisable to keep the breast skin open — aeration accelerates the healing of wet areas. Women with extensive rashes that make it difficult to feed can use special nozzles or, in extreme cases, express milk. When applying, it is important to ensure a neat grip of the nipple and alveoli with the baby’s mouth. Proper hygienic care of the skin of the mammary glands with the use of mild cleansers is required.
Prognosis and prevention
The prognosis is especially favorable for acute forms of the disease. The transition of eczema on nipple into subacute and chronic variants requires longer therapy, followed by compliance with a hypoallergenic diet, careful care of the nipple and alveoli, wearing natural underwear. For prevention, obstetricians-gynecologists and mammologists recommend in the last weeks before childbirth to lubricate the areoles with natural oils and creams-emollients that increase the elasticity of the skin. During your stay in the hospital, it is important to master the rules of breastfeeding and the peculiarities of the feeding regime. During lactation, it is necessary to refrain from eating foods that contribute to the occurrence of allergic reactions.