By Gary M. White, MD
Hyperkeratosis of the nipple in an older man.
Hyperkeratosis of the nipple (HN) represents the diffuse hyperkeratotic thickening of the nipples. It may be due to a variety of causes including: nevoidal condition, extension of epidermal nevus, manifestation of acanthosis nigricans, Darier disease, and chronic eczema. The nevoidal condition is usually seen bilaterally in women most often during puberty or pregnancy. Rarely, hyperkeratosis of the nipple may develop in association with CTCL [JAAD 1995;32;124].
One or both nipples may become partially or completely hyperkeratotic or verrucous. The changes may be limited to the nipple and areola or may extent onto the breast itself.
For cases unrelated to an epidermal nevus, a search for any signs of acanthosis nigricans should be performed. This is particularly common in those overweight individuals with elevated fasting insulin levels. Cryotherapy is a simple and potentially effective therapy. Other therapies that have been tried include topical steroids, salicylic acid, lactic acid, oral acitretin, surgical excision, and tretinoin. The CO2 laser was helpful in one nevoidal case [JAAD 1999;41;274]. Calcipitriol BID was helpful after 5 months in one case [JAAD 2002;46;131].
A 25-year-old woman with a 5-year history of thickening of both nipples. The verrucous thickening extended on the breast itself. Dermatology Online Journal 2016;22(2)
A 19-year-old woman with bilateral hyperkeratosis of the nipples since age 12. Pictures are shown before, during and 2 years after surgery. J of Cut and Aesth Surgery 2012;5;1;40
A 20-year-old woman presents with a warty growth over the left nipple and areola for 2 years. Images are shown before and after radio ablative surgery. J of Cutaneous and Asethetic surgery 2011:4;214-215
Three cases of HN in association with CTCL. Two of the cases did not show histologic features of CTCL, but one did. [Dermatopathology (Basel). 2015 Jul-Dec; 2(3): 61–66]
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