What it is and who gets it
Nipple eczema is localised inflammation of the nipple and areola, with redness and scaling. It can appear on its own or as part of wider atopic dermatitis, and it most often affects people who have or have had eczema elsewhere. It is most commonly diagnosed in teenage girls. Breastfeeding women without atopic dermatitis occasionally get it too.
Three routes in
- Atopic dermatitis — the same impaired barrier as anywhere else on the body.
- Irritant contact dermatitis — soaps, detergents and fragrances, plus, in practice, friction.
- Allergic contact dermatitis — from things applied to the area, including lanolin and preservatives, and from metals in piercings. Patch testing is how that gets confirmed.
That middle category is worth pausing on if you are breastfeeding, because nipple creams, pads and washes are exactly the kind of frequent, occluded, well-meant exposure that irritant and allergic dermatitis thrive on.
What it looks like
Acutely: red papules and plaques, sometimes with small blisters, oozing, crusting or erosions. Over time it becomes dry and scaly, with thickened (lichenified) skin on a red or hyperpigmented base. See thickened and darkened skin.
Treatment, including while breastfeeding
Topical corticosteroids are the usual first-line treatment, with moisturizers supporting the barrier. If you are breastfeeding, the practical guidance is to apply the steroid after a feed and wipe it off before the next one — but which preparation and how often is your doctor's or midwife's call, not a decision to make from a page. Our guide on eczema in pregnancy and breastfeeding covers the wider question of what is used when.
Cracked skin here is also a route for infection, and infection while feeding is its own problem — see the signs of infection and raise it early rather than pushing through.
The one thing to rule out. In adults, a one-sided nipple change that has persisted beyond about three months despite topical steroid treatment should be assessed to exclude mammary Paget disease — a rare form of skin cancer that can look like eczema. This is not a reason to panic about a sore nipple: most nipple eczema is nothing of the sort, and it affects both sides or settles with treatment. It is a reason not to keep quietly treating one stubborn side for a year. Get it looked at.
On mentioning it at all. This is a part of the body people leave off the list, and then leave off again the next time. Nobody examining skin for a living finds it remarkable. Say it — particularly if it's only one side.
Notice the three-month line
The rule that matters here is about time, and time is the thing memory is worst at. Ollowen's photo timeline gives a dated record of when something started and whether it's actually changing — which is exactly what turns “it’s been a while” into a date you can give a doctor.
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Sources
- DermNet. Nipple eczema.
- DermNet. Patch tests.
- National Eczema Society. Contact eczema (dermatitis).
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