Managing Infected Nipple Pits: Causes, Symptoms, and Treatment Options

Inflammation and the development of pustules with blood in a retracted nipple?

Hello, I am a patient with hyperthyroidism, but a year ago my doctor said I didn't need medication for control yet.
Currently, I have an inverted left nipple with a wound next to it, and recently I have been expelling greenish-white pus followed by bleeding and extreme pain.
The entire affected area is inflamed and swollen, and I have no place to seek medical attention during weekends and holidays.
I have seen other doctors who said it is due to enlarged sebaceous glands, similar to acne, which often accumulates white or green pus near the nipple before my menstrual cycle, and there is similar colored discharge from the nipple.
I have consulted several different doctors, and ultrasound examinations indicated that I have developed breast tissue and sebaceous gland issues.
Some described it as acne on the breast, and one even performed drainage.
Seven years ago, I caused inflammation in my left breast by forcefully squeezing the nipple, and after a month without medical attention, it intermittently discharged pus and then healed superficially until it recurred before my next menstrual cycle.
I improved with traditional Chinese medicine, but in recent years, staying up late and discontinuing the herbal treatment has made it very easy for the condition to recur.
The inverted nipple requires significant pressure to express, and if I don't apply pressure, it remains trapped inside.
If I neglect to clean the inverted area for just one day, it will recur the next day.
I always use a neutral cleanser.
Sometimes I can't help but touch the nipple.
During my development period, I didn't understand and kept pushing the nipple inward, which is not a congenital inversion.
The doctor suggested that if I continue to have recurrent acne (sebaceous gland) issues, I could see a dermatologist.
I haven't seen a dermatologist yet.
I want to ask what I should do to improve and reduce the chances of recurrence because I was diagnosed six months ago and have been suffering from long-term insomnia since then.
I often stay up late, and sometimes when I scrape my hands, the wounds heal slowly and turn into scars.
My diet is unbalanced.
What specialty should I consult, and what comprehensive examinations should I undergo?

Tong, 20~29 year old female. Ask Date: 2022/12/11

Dr. Yuan Tianmin reply Breast and Thyroid

Although you have described your situation in detail and shared your medical journey, I still recommend that you consult a breast surgeon to gain a better understanding.

Reply Date: 2022/12/11

More Info

Managing infected nipple pits can be quite challenging, especially when recurrent infections and inflammation occur. Based on your description, it seems that you are experiencing a condition that may involve sebaceous gland hyperplasia, which can lead to the formation of cysts or abscesses around the nipple area. This can be exacerbated by factors such as hormonal changes, skin hygiene, and possibly underlying health issues.

Causes:
1. Sebaceous Gland Hyperplasia: This condition occurs when the sebaceous glands become enlarged, leading to the formation of small cysts that can become infected.

2. Hormonal Fluctuations: Hormonal changes, particularly around menstruation, can increase oil production in the skin, leading to clogged pores and subsequent infections.

3. Poor Hygiene: Inadequate cleaning of the nipple area can allow for the accumulation of oils and bacteria, leading to infections.

4. Trauma or Irritation: Previous trauma to the nipple area, such as aggressive squeezing or irritation from clothing, can lead to inflammation and infection.

Symptoms:
- Pain and tenderness in the nipple area.

- Presence of greenish or whitish pus.

- Swelling and redness around the nipple.

- Bleeding from the affected area.

- Recurrent episodes of infection.

Treatment Options:
1. Proper Hygiene: Regularly cleaning the nipple area with a mild soap and water can help prevent the buildup of oils and bacteria. Avoid aggressive scrubbing, which can irritate the skin further.

2. Warm Compresses: Applying warm compresses to the affected area can help reduce inflammation and promote drainage of any pus.

3. Topical Antibiotics: If there is an active infection, your doctor may prescribe topical antibiotics to help clear the infection.

4. Oral Antibiotics: In cases of severe or recurrent infections, oral antibiotics may be necessary to treat the underlying infection effectively.

5. Dermatological Consultation: Since your doctor suggested seeing a dermatologist, this is a good step. A dermatologist can provide specialized care for skin-related issues, including potential treatments for sebaceous gland problems.

6. Avoiding Squeezing: It’s important to avoid squeezing or manipulating the nipple area, as this can worsen the condition and lead to further infections.

7. Hormonal Evaluation: Given your history of hyperthyroidism, it may be beneficial to have a comprehensive hormonal evaluation to rule out any underlying hormonal imbalances that could be contributing to your skin issues.

Lifestyle Modifications:
- Diet and Hydration: Maintaining a balanced diet and staying hydrated can improve overall skin health. Consider incorporating more fruits, vegetables, and whole grains into your diet while reducing processed foods.

- Sleep Hygiene: Since you mentioned issues with sleep, establishing a regular sleep schedule and practicing good sleep hygiene can help improve your overall health and potentially reduce stress-related skin issues.

- Stress Management: Chronic stress can exacerbate skin conditions. Engaging in stress-reducing activities such as yoga, meditation, or regular exercise may help.

Follow-Up:
It’s essential to follow up with your healthcare provider or a dermatologist for a thorough examination and tailored treatment plan. They may recommend further investigations, such as imaging studies or skin biopsies, if necessary, to rule out other conditions.

In summary, managing infected nipple pits involves a combination of good hygiene practices, appropriate medical treatment, and lifestyle modifications. By addressing these factors, you can reduce the likelihood of recurrence and improve your overall skin health.

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I would still like to have a breast surgeon examine you in person before proceeding with any treatment.