Young boy with lumps on both nipples

This is nipple eczema. It is a localised dermatitis involving the nipple and areola. This is frequently bilateral and fluctuates in severity. Lichenification due to scratching can be conspicuous, as can hyperpigmentation, particularly in skin of colour. It improves in response to topical steroids and can deteriorate rapidly when irritated by scratching, soaps, shower gels, and detergents.

Nipple eczema is a common local manifestation of atopic dermatitis but can occur in isolation.

Patients should avoid any precipitating irritants and allergens. Regular emollients and topical corticosteroids are the mainstay of treatment. Moderate potency topical steroids are usually very effective, followed by low potency topical steroids as maintenance therapy if necessary. Topical coal tar preparations are an effective old fashioned remedy.

Sometimes, use of a potent topical steroid with hydrocolloid dressing occlusion for a few days will break the itch-scratch cycle that perpetuates the problem.

• Mammary Paget disease (this is usually unilateral in older patients)
• Allergic contact dermatitis (often from medicaments)
• Fungal infection
• Bacterial infection
• Bowen disease