Medical News Today: Common nipple problems and their causes

Discharge, pain, and itching are common nipple problems that can affect anyone. But what causes these conditions and how can they be treated?

Nipple problems can lead to discomfort from time to time in any individual, but most causes are not serious. Some symptoms, however, could indicate an underlying health condition.

This article explores the symptoms, causes, and treatments for common nipple problems.

Symptoms

Woman pulling her bra open to nipple problems
Symptoms of nipple problems may include swelling or cracked skin.

Symptoms of nipple problems may include:

  • discharge from the nipples, including clear, milky, green, yellow, or brown fluid
  • nipples that are itchy or irritated
  • nipples that are cracked or bleeding
  • nipples that are swollen and painful
  • nipples that change shape
  • changes to the area around the nipple, including skin puckering or dimples


Causes of common nipple problems

There can be several causes of nipple problems. These include the following:

Ectasia

Ectasia is a non-cancerous breast condition in which the milk ducts become wider.

For some people, ectasia may lead to a blockage in the milk duct. This can cause fluid to pool and leak into the surrounding tissue. A blocked milk duct can lead to:

A milk duct infection can cause pain in the breast and a thick, sticky fluid to discharge from the nipple. It may also lead to scar tissue forming. Sometimes, this can result in the nipple being drawn inward or becoming inverted.

Intraductal papilloma

Intraductal papilloma is a small, harmless wart-like lump. The lump grows inside the milk duct and is usually close to the nipple. The condition is not cancerous.

Intraductal papilloma may cause blood or a sticky fluid to discharge from the nipple.

Galactorrhea

Galactorrhea is a milky discharge from one or both nipples that is not related to breast-feeding.

It is a relatively common problem that affects up to 25 percent of women. Less commonly, anyone, including infants, can develop galactorrhea.

An increase in levels of prolactin, the hormone that stimulates milk production, is often the cause of galactorrhea . Possible reasons for this include:

  • sleeping pills and sedatives
  • antidepressants
  • blood pressure medicines
  • antipsychotics
  • high doses of estrogen, such as from oral contraceptives
  • marijuana
  • herbs, such as anise, fennel, or fenugreek seed
  • repeated nipple stimulation or manipulation

Low testosterone levels may cause galactorrhea in some men.

Lactational mastitis

Lactational mastitis is a condition that can develop in women who are breast-feeding. It causes the breast to become red, painful, and swollen.

Lactational mastitis happens due to poor milk drainage and can result from an injury to the nipple. It leads to swelling of the breast tissue and compression of the milk duct.

The condition can involve an infection, and an abscess may develop behind the nipple. This may cause nipple discharge, which can be difficult to detect, as there is also normal milk production occurring.

Breast abscesses may affect up to 11 percent of lactating mothers.

Paget disease of the breast

Paget disease of the breast is a rare form of breast cancer. Most commonly, it affects women, but it can also develop in men.

This form of cancer may affect the nipple and skin or areola around the nipple. If a person has the condition, they may also have one or more tumors inside the breast.

Symptoms of Paget disease of the breast can include:

  • itching, tingling, or redness of the nipple or areola
  • flaky, crusty, or thick skin around the nipple
  • a nipple that appears more flat than usual
  • yellow or bloody discharge from the nipple

Other causes

Other possible causes of nipple problems include:

  • irritation from excess rubbing caused by exercise or sexual activity
  • thyroid problems
  • pituitary gland tumor, which is normally harmless


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When to see a doctor

female gp in consultation with her patient
A doctor will discuss a patient’s symptoms and medication before diagnosis.

People should consult a doctor if they have:

  • nipple discharge when they are not breast-feeding
  • nipple discomfort that lasts for more than a few days
  • nipple discharge associated with a lump in the breast
  • changes to the skin around the nipple, including color changes or pulling from under the skin
  • signs of infection with breast pain or discharge, plus fever or chills


How are nipple problems diagnosed?

Diagnosis of nipple problems is done in several ways.

Firstly, the doctor will ask about a person’s symptoms, any medicine they may be taking, and if they are pregnant or breast-feeding. Next, they may examine a person’s breasts.

The doctor should then have an idea of what the problem could be. Depending on what they think the cause could be, the doctor will then conduct one of the following tests:

  • Ductography. This is where the doctor injects dye into the breast ducts so they can see if there are any blockages.
  • Mammogram or breast ultrasound. These are imaging tests that reveal any lumps in the breast.
  • Skin biopsy. This is a test to see if there are any cancer cells in the skin.
  • Prolactin test. This is a blood test to check the levels of the hormone that stimulates milk production.
  • Thyroid hormone test. This is a blood test to check if the thyroid gland is working properly.

If none of these tests are conclusive, the doctor may conduct a CT or MRI scan to examine the breast further.

Treatment

There are a number of different treatments available for nipple conditions, depending on the cause.

Ectasia

Treating ectasia symptoms can be done with a warm compress placed on the area. This helps to soothe pain and reduce inflammation.

A course of antibiotics may be needed to treat an infection. In more severe cases, surgery may be required to remove the affected milk duct.

Intraductal papilloma

Removing the affected milk duct is the method used to treat intraductal papilloma.

Galactorrhea

Treatments for galactorrhea depend on the underlying cause. If the cause is medication, a doctor may recommend stopping the treatment. They may recommend a suitable alternative medication.

A doctor can also prescribe a medication to reduce prolactin production to treat galactorrhea.

Lactational mastitis

Treatment for lactational mastitis may be antibiotics, which can clear the infection. A doctor will prescribe a type of antibiotic that will not harm the child through the mother’s breast milk.

An abscess can be drained using ultrasound to locate it or through an incision.

Paget disease of the breast

Paget disease of the breast may require a mastectomy, which is a surgical operation to the remove the affected breast. An alternative to a mastectomy is removal of the nipple followed by radiation therapy.


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Prevention

Woman shopping for a bra
Some nipple problems may be prevented by wearing suitable clothing during exercise.

Some nipple problems are preventable. The following can help to promote nipple health:

  • keeping the nipples clean when breast-feeding
  • wearing suitable clothing during exercise to avoid friction
  • using products to prevent chaffing
  • changing or stopping any medication that could be causing nipple problems, after consulting a doctor

Outlook

Most nipple problems are not serious and are easily treated. To be safe, people who notice any breast changes should see their doctor so that the correct diagnosis can be made.

Paget disease of the breast is more severe but still treatable. People who notice any symptoms of this condition should see their doctor straightaway.

Starting treatment as soon as possible gives a person the best opportunity to recover fully.

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