Inflammation of the nipple

In mammology, the nipple inflammation is considered to be one of the varieties of mammary gland pathologies. Most often this condition is manifested and diagnosed in lactating women (in combination with postpartum mastitis). His code for the ICD 10 - class XV (pregnancy, childbirth and the puerperium) - O91.0 (related to the birth of infection of the nipple).

However, there are non-lactation-related inflammations of the nipple (telitol), as well as inflammation of the areola of the nipple (areolite); according to ICD 1, their code is N61 (breast disease). Problems with nipple inflammation can occur not only in women, but also in men.

[1], [2], [3], [4], [5], [6]

Causes of the inflammation of the nipple

In most cases, the pathogenesis of nipple inflammation and the surrounding areola is of an infectious nature. Infection - as a rule, Staphylococcus aureus or Streptococcus agalactiae - penetrates the nipple through the milk pores located on its upper surface or through the cracks and other microdamages present on the nipple. The result may be staphylococcal pyoderma of the nipple (impetigo) or streptococcal pyodermatosis - pustular inflammation of the areola nipple. Perhaps the appearance of a furuncle in the vicinity of the nipple.

The following possible causes of nipple inflammation are also noted:

• dry skin, resulting in the appearance of nipple cracks;
• trauma to the nipple;
• Dermatosis (occurs due to irritation of the skin with linen and clothing, detergents and cosmetics, etc.);
• eczema nipple (for more details see - Eczema on the nipples );
• Candidiasis (Candida albicans fungus);
• defeat of the nipple HSV (herpes virus);
• ectasia of the milk ducts (plasmacytic or comedomastitis) in women in the perimenopausal period;
• intraductural (intra-flow) papillomas.

In addition, nipple inflammation in women is one of the symptoms of benign formation in its ducts - adenomas, and also can be with primary hypothyroidism, that is, a lack of thyroid hormones (resulting in a disbalance of the TSH-releasing hormone and increased prolactin synthesis).

In addition to the above causes of inflammation in the nipple region (except the last two), nipple inflammation in men often accompanies gynecomastia - a pathological increase in the mammary glands associated with endogenous imbalance of hormones in the body or taking anabolic steroids. Also, men with immune deficiency and diabetes mellitus are affected by these inflammations.

Mammologists emphasize that the inflammation of the nipple in women, which has the form of squamous dermatitis or wet eczema, can actually be a symptom of Paget's cancer-a cancer of the nipple and its areola.

[7], [8]

Symptoms of the inflammation of the nipple

As doctors rightly remark, the symptoms of nipple inflammation can vary depending on its cause, intensity and individual characteristics of the body. Signs of nipple inflammation in women, like the symptoms of nipple inflammation in men, can be permanent or felt only when the nipple is examined or squeezed; can gradually increase for a long time, but can appear suddenly, for example, as an inflammation of the nipple during pregnancy, as well as inflammation of the nipples during breastfeeding. Symptoms can manifest in one breast or both. Damage to the nipples in the form of cracks lead to extreme soreness in the course of feeding the baby, and from the cracks may be allocated syvic and even blood. Infection causes the appearance of purulent discharge, and the first signs of inflammation of the teat infectious etiology may suddenly appear and include: edema of the nipple or the entire breast; increased nipple sensitivity, soreness and itching; pain or burning during breastfeeding; redness of the skin; a painful "lump" in the chest; feeling of heat in the mammary gland; increase in body temperature to + 38.5 ° C or more, chills; increased axillary and cervical lymph nodes; general weakness.

Symptoms of papillary nipple inflammation are manifested by the appearance of erythema and flaking of reddened skin; at an eczematous origin of a pathology - an itch, a burning sensation, reddening of a nipple and an areola with formation of the wetting sites covered with scabs. Fungal inflammation of the nipple with similar signs in a nursing mother can cause candidiasis (thrush) in the infant's mouth. See -  Treatment of thrush in newborns. And for herpesvirus inflammation is characterized by severe itching and papules with serous contents.

The signs of impetigo in the nipple region are reddening and puffiness of the dermal parts with the formation of small abscesses, which after spontaneous dissection are transformed into crusts, and ulceration occurs under them. Body temperature is subfebrile, and patients complain of general poor health.

In ductal ectasia (usually bilateral), the symptoms of nipple inflammation are expressed by pain, pruritus, edema and sticky secretions. When the areola is palpated, it is often possible to reveal the tubular structures of the dilated ducts.

To already noted clinical signs for inflammation of the nipple caused by the adenoma, you should add a palpable, elastic rounded formation in the tissues of the nipple.

The first signs of inflammation of the areola of the nipple that resulted from the inflammatory process in Montgomery's glands are manifested in the swelling of one or several tubercles, their soreness and the appearance of brownish or colorless discharge.

If the inflammation around the nipple is caused by hydradenitis, then the inflammatory purulent nodule in the nipple appears (primarily painful on palpation), then the nipple swells and turns red, and after punching out, the pus is discharged to the outside.

[9], [10], [11], [12]

Forms

Inflammation of the nipple during pregnancy and breastfeeding

Inflammation of the nipple during pregnancy can be a consequence of all of the above factors, which have a stronger pathogenic effect due to a physiological decline in immunity and suppression of mononuclear phagocytosis in pregnant women.

Obvious and well-known causes that cause inflammation of the nipples during breastfeeding include:

• associated with lactation of a nipple crack (ICD 10 - O92.1) and their infection;
• injury to the nipples during the feeding of the child due to errors in applying it to the chest;
• lactostasis and acute lactational mastitis, which develops against the stagnation of milk;
• bacterial mastitis (bacterial infection of the milk ducts);
• non-compliance with maternal hygiene during lactation.

80% of children born to the world have breastfeeding, which many perceive as an inflammation of the nipples in newborns. This phenomenon, according to the assurances of pediatricians, despite the possible isolation from the nipples, does not pose a danger and passes with time, as the female sex hormones that they received from the mother during the intrauterine development period gradually leave the baby's blood. The main thing is to observe hygiene and make sure that engorgement does not develop into inflammation - with redness and fever, characteristic of newborn mastitis.

[13], [14], [15], [16], [17]

Inflammation of the areola nipple

Inflammation around the nipple (areolitis) occurs when:

• Inflamed the periareolar glands of Montgomery (located near the nipple of sebaceous glands). Possible causes of such inflammation - characteristic of these glands "clogging" and secondary bacterial infections; Inflammation is local and very rarely produces systemic reactions.
• Zusk's disease develops, that is, a hypodermic abscess of the paraspine zone with a mummillar fistula (fistula). The pathogenesis of the disease is associated with the appearance of epithelial squamous cell metaplasia, which leads to obstruction of the milk ducts. It can be like in unkempt women, and in men with excessive body weight.
• arises localized in the areola of the nipple of hydradenitis (since there are sweat glands in the areola).
• under the influence of Staphylococcus aureus folliculitis (inflammation of hair bulbs areola).

Purulent inflammation of the areola of the nipple of hormonal origin is the diagnosis of predominantly young patients. But the appearance of it in pregnant doctors explain that the size of the areomers and glands Montgomery during gestation is significantly increased, while the secretion of sebum that clogs them increases.

Diagnostics of the inflammation of the nipple

Initially, the diagnosis of nipple inflammation involves examining and palpating the mammary glands and recording all patient complaints.

Then - to determine the exact diagnosis - the doctor prescribes tests; it can be a general blood test and biochemical analysis (to the level of hormones - genital and thyroid gland, as well as HPV and oncomarkers - with suspicion of papilloma and Paget's cancer); scraping or sowing of discharge from the nipple for the presence of bacterial infection, fungus Candida, HSV.

Instrumental diagnostics, such as radiography of mammary glands (mammography), doktografiya (research of milk ducts), ultrasound are used.

Because many of the symptoms of intra-cellular Paget's cancer are similar to those of nipple inflammation or their eczema, differential diagnosis is necessary. If suspected of Paget's cancer, biopsies of the nipple skin and its histological examination are prescribed.

Diagnosis of nipple inflammation in men may require an immunochemiluminescent blood test for the main steroid male and female hormones.

[18], [19], [20], [21], [22]

Treatment of the inflammation of the nipple

Treatment of nipple inflammation is prescribed depending on its cause, established by the doctor during the examination of each patient.

In bacterial nipple inflammation, the use of antibiotics (such as Ampicillin, Gentamicin, Oxacillin, Clindamycin, etc.) is necessary. Also, tetracycline ointment, synthomycin emulsion, Clotrimazole ointments, Levomecol and others are prescribed. Nipples should be washed daily with a soda solution (teaspoon per 250 ml of warm water) or alcohol-free antiseptic solutions (Chloroxylene, Chlorhexidine, Cetrimide).

The ointments Actovegin and Solcoseryl promote the healing of inflamed nipples due to the stimulation of tissue trophism. Pregnant and lactating women are contraindicated in their use.

Inflammation of the nipples during pregnancy and breastfeeding is treated with the help of dexpanthenol ointment (D-Panthenol) or Bepanten plus cream. Read more about antibiotics for breastfeeding.

Medications for inflammation around the nipple caused by hydradenitis include oral antibiotics (Amoxicillin, Doxycycline, Lincomycin) that take a course within one to two weeks. Outside, the inflammation is treated with a slightly warm solution of table salt, and also apply ointments containing antibiotics (Mupirocin, Levomikol, etc.). It may require surgical treatment - opening the exudative cavity and draining it. The surgeon's help is sometimes needed to open up long-lasting abscesses of a different etiology, as well as in cases of obstruction or ectasia of the milk ducts.

Herpes on the nipples and areolas is usually treated by a dermatologist who prescribes such medicines in the form of ointments like Acyclovir, Zovirax, Bactroban, etc. Fungal infections (Candida) require ingestion of antifungals and the use of ointment Nystatin, Miconazole, Mycostatin, Clotrimazole, Terbinafine or Zalain, which are not used during pregnancy and lactation.

Complications for some causes of inflammation of juices can be in the form of scarring and maiming of the breast. And life-threatening consequences include, first and foremost, the whole body's inflammatory reaction to infectious nipple inflammation and bacterial mastitis-sepsis.

Alternative treatment for nipple inflammation and homeopathy

Applying any alternative treatment, one should keep in mind: the process of infectious inflammation with the formation of pus requires drug therapy, and to try to fight bacteria without antibiotics in this situation is not worth it.

However, many home remedies for inflamed nipples are offered, for example:

• If the cause of nipple inflammation is breastfeeding, you can use your own breast milk, applying it to the affected nipple before and after feeding, allowing it to dry completely in the air.
• A warm 10-minute compress on the inflamed nipples (only in the absence of purulent inflammation).
• Careful massage of the nipples with warm olive or almond oil (tablespoon) with the addition of two or three drops of tea tree oil, which has antiseptic properties.
• Massage the affected area with an ice cube wrapped in a sterile tissue.
• Lubricate the nipples with fresh aloe juice 4 times a day for three days (before washing the child must be washed off - so that the baby does not have diarrhea).

To conduct treatment with herbs is recommended with the help of powdered basil leaves, which are made from fresh plant and applied to nipples and otolary zones three times a day for a week. In the same way, you can use the flowers of marigold, which will successfully replace the essential oil of calendula (4-5 drops) mixed with olive (tea or dessert spoon).

Anti-inflammatory and antimicrobial properties of camomile help to treat inflammation of the nipple during pregnancy and breastfeeding (compresses are made with a decoction of chamomile or irrigation of their nipples).

Homeopathy is inapplicable during the period of the child's fostering and breastfeeding. In other cases, homeopaths offer patients the remedies Alumen, Arnica, Calcarea carbonica, Chamomilla, Graphites, Sanguinaria (for the right breast nipple) and Silicea (for the left nipple).

[23], [24]

Prevention

The best prevention of nipple inflammation is the impeccable cleanliness of the nipples themselves and everything that comes into contact with them, and unconditional hygiene, first of all, pregnant and lactating. Particular attention to this issue should also be given to men.

It is extremely important, even before the birth of a child, to have a complete idea of how to properly apply it when feeding. During lactation, women are advised to avoid daily washing of the nipples and the entire breast with soap, although it is possible to use a quality baby soap. It is also necessary to wear linen made from natural fabrics, in particular cotton. Often, nipples should be exposed to air and ultraviolet radiation. For health and its maintenance, more patients with this pathology are recommended more vitamin C - an active antioxidant.

[25], [26], [27], [28], [29]

Forecast

It is clear that the prognosis of inflammation completely depends on its cause, but for the majority it is favorable, except for cases when the nipple inflammation concealed the cancer.

[30], [31], [32], [33], [34]