The nipple is the sensitive, darkly-pigmented part of the breasts. Medically speaking, a collection of numerous tiny milk-conducting ducts forms a common outlet at the nipple from where milk is ejected during breastfeeding. Nipples are generally well moisturized by glands present below the skin that keep them free of infection and dryness.
Itching of nipples is fairly common and could be due to atopic dermatitis (eczema), breast cancer, allergies, seen during menopause and very rarely in Paget’s disease. The commonest cause of all is eczema. The medical term for eczema is atopic dermatitis. There is presence of a characteristic rash with itching, tiny eruptions and redness around the areola in eczema, which is a reaction to an allergen. On taking a detailed history, presence of certain allergens can be identified. Other trigger factors may be dry skin, cold and dry environment, prolonged contact with water, especially long hot showers. The best treatment for such itching is to avoid exposure to trigger factors and refuel the moisture of the skin by applying oils or creams to the nipple; especially in people who are prone to cracking and dryness of nipples. Avoid extremely hot water for bathing, as it steals the moisture from the skin leaving the nipples dry and itchy. A dermatologist or gynecologist should be consulted for local applications or oral medication to control eczema.
Itching could also be due to an allergy to the contents of soaps/detergents or to the material of undergarments. This could lead to excessive and prolonged itching as well as raised serum histamine levels. The best solution is to avoid contact with strong chemical liquids and soaps and use mild soaps/detergents. During an acute attack of itching, taking antihistamines will provide tremendous relief. Patients should also stick to wearing cotton undergarments which are not too tightly fitted. Often, itching of nipples is experienced by people who tend to run/jog a lot. This produces intense friction of the skin with the undergarments and sweating worsens it. Friction against wet clothes causes redness, soreness of nipples and itching. If these patients wear comfortable, cotton undergarments, it will reduce both the sweating and friction and give the skin relief from itching.
The rarest cause of all could be a form of breast cancer .i.e. Paget’s disease. It begins with tremendous itching of the nipples and areola. There may be an unusual discharge from the nipple too. If the itching is not relieved with oral medications and topical (local) applications as seen in eczema, then Paget’s disease should be tested for. Investigations for Paget’s disease involve a complete physical check up, mammography, ultrasonography or even sono-mammography. Once the diagnosis is made, depending on the area involved, either a complete resection of the breast is done or a conical excision of the nipple and areola may be advised by the surgeon.
Excessive itching and scratching could lead to cracks and bacterial infections. Care should be taken to apply petroleum jelly over nipple cracks to prevent them from worsening. The use of mild soaps is always encouraged to prevent dryness and thus, itching of nipples.
Itching of nipples is a very common symptom but it should not be neglected. As soon as itching of nipple starts it should be taken care of with petroleum jelly, moisturizers, and improved personal hygiene. If it does not improve, a dermatologist should be consulted for appropriate diagnosis and medications.