I too have seen a few women with hyperkeratosis of the nipple and/or the
areola. This is typically defined as an overgrowth of melanocytes or a nevoid
defect affecting women of childbearing age. One artcile believes there is a
correlation between this type of hyperkeratosis and endogenous or exogenous
estrogen levels. Lesions often appear and or worsen during pregnancy. The
lesions are typically thickenings of the nipple/areola and show brown
hyperpigmentation.

This is sometimes treated during pregnancy and/or during lactation with such
medications as salicylic acid gel, topical tretinoin (Retin-A), lactic acid
lotion, or light cryotherapy. Mostly what I have seen is the thickened layers
peeling off during the course of breastfeeding, leaving some very tender skin
underneath. Proper positioning, latch, and suck are very important to these
mothers. I have recommended using moisturizing lotions to prevent this
overgrowth from adhering so tightly that bleeding occurs when it sloughs off.
A dermatologist told me that he will sometimes recommend Retin-A because as
the Hale book says, it stimulates epithelial cell turnover and reduces cell
cohesiveness.

A summary of this condition as well as other dermatologic conditions that
affect the breast and nipple can be found in:

Whitaker-Worth DL, et al. Dermatologic diseases of the breast and nipple.
Journal of the American Academy of Dermatology 2000; 43:733-751

Marsha Walker, RN, IBCLC
Weston, MA

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