Hyperkeratosis of the nipple and areola.

What is it hyperkeratosis of the nipple?

Nipple hyperkeratosis and areola describes warty thickening of the nipples and areolae [1–5]. Can be primary (idiopathic) or secondary to another disorder (see differential diagnosis)

Hyperkeratosis of the nipple and areola is also called nevoid hyperkeratosis and hyperkeratosis areolae mammae naeviformis.

Who gets hyperkeratosis of the nipple?

Primary hyperkeratosis of the nipple usually occurs in adolescent females, and rates in males are much lower. [1,2,4]. No ethnic or geographic links have been reported.

What causes nipple hyperkeratosis?

The exact cause of nipple hyperkeratosis is unknown. Although no hormonal alterations have been found, a endocrinological cause has been proposed because of its association with the female sex, estrogen therapy and pregnancy [1].

What are the clinical features of nipple hyperkeratosis?

The clinical features associated with hyperkeratosis of the nipple follow.

• Hyperkeratosis is localized to the nipple and areola (although the entire breast can be affected) [1,5]
• is usual bilateral [1,2]
• It appears as warty hyperpigmented plates [1,4]
• The plates are usually asymptomatic; and occasionally itching [1,3].

What are the complications of nipple hyperkeratosis?

Nipple hyperkeratosis can cause embarrassment and cosmetic problems. [5]. There are some reported cases of difficulty breastfeeding from the affected breast [1].

How is hyperkeratosis of the nipple diagnosed?

The diagnosis of hyperkeratosis of the nipple depends on the clinical presentation of the hyperkeratotic license plate(s) and skin findings biopsy if the presentation is atypical.

Histopathological Characteristics of nipple hyperkeratosis are:

• Oterokeratotic hyperkeratosis
• Papillomatosis
• Acanthosis
• Keratotic plug
• A slight perivascular lymphocytic infiltrate at dermis [1,4].

What is the differential diagnosis for hyperkeratosis of the nipple?

Secondary hyperkeratosis of the nipple. [1,2,5] is usually unilateral. Examples include:

• Seborrheic keratosis – these present as one or more discreet, right-circumscribed injuries
• Papillomatous melanocytic nevus (mole) – onset is in infancy
• Epidermal naevus – to congenital linear warty license plate

• Leiomyoma of the nipple and areola (genital type) – a rare benign neoplasm; typically a loner nodule [3]

• Acanthosis nigricans – usually affects skin folds, but can involve the nipple and areola

• Papillomatosis of the nipple, in which papules arise from the lactiferous duct

• Runner's or cyclist's nipple: Associated with a history of chronic rubbing

• Mammary Paget's disease of the skin: unilateral and clinically Rev .histologically distinct

• Other evil one skin injury, as basal cell carcinoma, scaly cell carcinoma, or melanoma
• Cutaneous T cell lymphoma (mycosis fungoides): rare cases confined to the nipple have been described.

Unilateral hyperkeratosis of the nipple associated with pain, bleeding, ulceration, download, or nipple retraction should be investigated with breast exam, mammography, and biopsy, if breast Cancer.

Bilateral secondary hyperkeratosis of the nipple and areola can occur with:

• Ichthyosis
• Atopic dermatitis
• Psoriasis
• Darier's disease

• Targeted cancer therapies (such as vemurafenib).

What is the treatment for hyperkeratosis of the nipple?

Untreated hyperkeratosis of the nipple does not tend to interfere with normal breast function. However, treatment of the lesion is usually justified for cosmetic reasons. [4.5].

Cryotherapy It is a suitable first-line treatment for hyperkeratosis of the nipple, often giving a cosmetically satisfactory result. [4.5]. It may need to be repeated. Hypopigmentation is the main long-term risk of cryotherapy.

Medical treatments do not remove the lesions permanently but keratolytic agents (such as salicylic acid, lactic acid or urea), current retinoidsand calcipotriol may be useful [2,5].

Skin surgery or To be Resurfacing is sometimes done but can be cosmetically unsatisfactory. [5].

What is the result of nipple hyperkeratosis?

Without treatment, nipple hyperkeratosis persists.

Cryotherapy or surgical excision reduces reappearance [4,5].