Itchy Nipples: Causes, Symptoms, and Treatment Options

Nipple itching, exudate, crusting?

The left nipple often feels itchy, and I have noticed crusting.
After removing the crust, it seems like there is a red, moist wound, but when I press it with tissue, it doesn't feel wet.
After about half an hour, the nipple skin returns to normal.
However, after a day, before showering, I noticed what seems to be a layer of transparent hard skin.
I ignored it, but after a few days, it turned into crust, and there was even yellow fluid.
I saw a small drop outside the crust, but squeezing it doesn't produce more, as I also felt a hard lump.
Therefore, I went to Taichung Veterans General Hospital to see a general surgeon, and I underwent a breast ultrasound.
The doctor said it looks like a blister and that there is nothing concerning.
The itchiness of the nipple might be due to eczema, and the crusting could be caused by secreted milk (I stopped breastfeeding 9 years ago).
The doctor advised me to take care of my breasts by applying lotion, but I still feel anxious seeing the yellow, sticky discharge.
After researching, I found reports that unilateral nipple itching could be related to Paget's disease.
Ultrasound and mammography may not be able to determine this; is it necessary to perform a nipple biopsy for diagnosis? Will it be very painful? Thank you, doctor, for your response.

Man Er, 30~39 year old female. Ask Date: 2022/03/27

Dr. Chen Jiaming reply Surgery

The yellow discharge from the scab is interstitial fluid from the body.
There are many reasons for the superficial wounds (abrasions) on the nipple.
When a wound occurs, a light discharge will appear, which can accumulate over time and form a scab.
During the healing process, itching symptoms may arise, making it easier to disturb the scab, leading to a continuous cycle of irritation.
Applying ointment and avoiding the removal of the scab are essential for a chance at complete healing.
This situation is similar to eczema (itching, etc.), and you may consider using a combination topical ointment or oral antihistamines.
As for a biopsy, it may not be necessary since you have already consulted a breast specialist (General Surgery at Taichung Veterans General Hospital), and it does not appear to resemble the typical changes associated with Paget's disease.
The biopsy process can be quite painful, and importantly, it will not resolve your underlying issue.

Reply Date: 2022/03/27

More Info

Itchy nipples can be a concerning symptom, especially when accompanied by crusting, redness, and discharge. Understanding the potential causes, symptoms, and treatment options is crucial for addressing this issue effectively.

Causes of Itchy Nipples
1. Dermatitis: One of the most common causes of itchy nipples is dermatitis, which can be due to contact with irritants or allergens. This could include soaps, lotions, or fabrics that irritate the skin.

2. Eczema: Eczema can also lead to itchy and inflamed skin, including the nipple area. It often presents with dry, flaky skin and may require specific treatments to manage.

3. Infections: Bacterial or fungal infections can cause itchiness and discharge. Conditions like candidiasis (a yeast infection) can lead to symptoms similar to what you are experiencing.

4. Paget's Disease of the Nipple: This is a rare type of breast cancer that can cause itching, redness, and discharge from the nipple. It is essential to rule this out, especially if there are persistent symptoms.

5. Hormonal Changes: Hormonal fluctuations, particularly those related to menstruation or menopause, can lead to changes in the skin and may cause itchiness.

Symptoms
The symptoms you described, including crusting, redness, and the presence of a yellowish discharge, are significant. The crusting could be due to dried secretions, while the yellow discharge may suggest an underlying infection or irritation. The presence of a hard lump could also indicate a cyst or another benign condition.

Diagnostic Approach
Given your symptoms and the results of the ultrasound indicating a possible cyst, it is understandable to have concerns about the nature of the discharge and the hard lump. While your doctor has suggested that it appears benign, further investigation may be warranted, especially if symptoms persist or worsen.

1. Breast Ultrasound: This imaging technique is useful for evaluating breast lumps and can help differentiate between solid masses and fluid-filled cysts.

2. Mammography: This is another imaging tool that can provide additional information about breast tissue and help identify any abnormalities.

3. Nipple Biopsy: If there is a suspicion of Paget's disease or if the symptoms do not resolve with conservative treatment, a nipple biopsy may be recommended. This procedure involves taking a small sample of tissue for examination. While it may cause some discomfort, it is generally well-tolerated, and local anesthesia is often used to minimize pain.

Treatment Options
1. Topical Treatments: If dermatitis or eczema is diagnosed, topical corticosteroids or moisturizers may be prescribed to reduce inflammation and itching.

2. Antibiotics or Antifungals: If an infection is suspected, appropriate medications will be necessary to treat the underlying cause.

3. Regular Care: Maintaining good hygiene and using gentle, fragrance-free products can help prevent irritation.

4. Monitoring: Keeping an eye on the symptoms and any changes in the discharge or lump is essential. If symptoms persist or worsen, further evaluation by a healthcare provider is necessary.

Conclusion
While your doctor has provided reassurance regarding the benign nature of your symptoms, it is essential to remain vigilant. If you notice any changes, such as increased discharge, changes in the lump, or persistent itching, follow up with your healthcare provider. Early detection and treatment are key to managing any potential issues effectively. If a biopsy is recommended, discussing any concerns about pain or the procedure with your doctor can help alleviate anxiety and ensure you are well-informed.

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