Inflammation of the nipple

In mammology, inflammation of the nipple is considered one of the types of pathologies of the mammary glands. Most often, this condition manifests itself and is diagnosed in nursing women (in combination with postpartum mastitis). Its code according to ICD 10 is class XV (pregnancy, childbirth and the postpartum period) - O91.0 (childbirth-related nipple infections).

However, non-lactational inflammation of the nipple (calitis) and inflammation of the areola of the nipple (areolitis) are observed; according to ICD 1, their code is N61 (diseases of the mammary gland). Problems with inflammation of the nipples can occur not only in women, but also in men.

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Causes nipple inflammation

In most cases, the pathogenesis of inflammation of the nipple and the surrounding areola is infectious. The infection, usually Staphylococcus aureus or Streptococcus agalactiae, penetrates the nipple through the milky pores on its upper surface or through cracks and other microdamage on the nipple. The result may be staphylococcal pyoderma of the nipples (impetigo) or streptococcal pyoderma - pustular inflammation of the areola of the nipple. A furuncle may also appear in close proximity to the nipple.

The following possible causes of nipple inflammation are also noted:

• dry skin leading to cracked nipples;
• nipple trauma;
• dermatosis (occurs due to skin irritation from linen and clothing, detergents and cosmetics, etc.);
• eczema of the nipple (for more details, see Eczema on the nipples );
• candidiasis (infection by the fungus Candida Albicans);
• HSV (herpes virus) nipple lesion;
• ectasia of the milk ducts (plasmacytic or comedomastitis) in women in the perimenopausal period;
• intraductal papillomas.

In addition, inflammation of the nipple in women is one of the symptoms of a benign formation in its ducts - adenoma, and can also occur with primary hypothyroidism, that is, a deficiency of thyroid hormones (leading to an imbalance of TSH-releasing hormone and increased synthesis of prolactin).

In addition to the listed causes of inflammation in the nipple area (except for the last two), nipple inflammation in men often accompanies gynecomastia - a pathological enlargement of the mammary glands associated with endogenous hormonal imbalance in the body or the use of anabolic steroids. Men with immune deficiency and diabetes are also susceptible to such inflammations.

Mammologists emphasize that inflammation of the nipple in women, which looks like squamous dermatitis or weeping eczema, may in fact be a symptom of Paget's disease - an oncological disease of the nipple and its areola.

Symptoms nipple inflammation

As doctors quite rightly note, the symptoms of nipple inflammation may vary depending on its cause, intensity and individual characteristics of the body. Signs of nipple inflammation in women, like symptoms of nipple inflammation in men, can be constant or felt only during examination or compression of the nipple; they can gradually increase over a long period of time, but can appear suddenly, for example, as nipple inflammation during pregnancy, as well as nipple inflammation during breastfeeding. Symptoms can appear in one breast or in both at once. Damage to the nipples in the form of cracks lead to extreme pain during feeding the baby, and ichor and even blood can be released from the cracks. Infection causes the appearance of purulent discharge, and the first signs of nipple inflammation of infectious etiology can appear suddenly and include: swelling of the nipple area or the entire mammary gland; increased sensitivity of the nipple, soreness and itching; pain or burning during breastfeeding; redness of the skin; a painful "lump" in the breast; a feeling of heat in the mammary gland; an increase in body temperature to +38.5°C or more, chills; enlarged axillary and cervical lymph nodes; general weakness.

Symptoms of dermatous nipple inflammation are manifested by the appearance of erythema and peeling of reddened skin; with an eczematous origin of the pathology - itching, burning, redness of the nipple and areola with the formation of weeping areas covered with scabs. Fungal inflammation of the nipple with similar symptoms in a nursing mother can cause candidiasis (thrush) in the baby's oral cavity. See - Treatment of thrush in newborns. And for herpesvirus inflammation, severe itching and papules with serous contents are characteristic.

Signs of impetigo in the nipple area are redness and swelling of the dermis with the formation of small abscesses, which after spontaneous opening transform into crusts, and ulcers appear under them. The body temperature is subfebrile, and patients complain of general poor health.

In ductal ectasia (usually bilateral), the symptoms of nipple inflammation include pain, pruritis, swelling, and sticky discharge. Palpation of the areola often reveals tubular structures of dilated ducts.

To the already noted clinical signs of nipple inflammation caused by adenoma, one should add a palpable elastic round formation in the nipple tissue.

The first signs of inflammation of the areola of the nipple, which is the result of the inflammatory process in the Montgomery glands, are manifested in the form of swelling of one or more tubercles, their soreness and the appearance of brownish or colorless discharge.

If inflammation around the nipple is caused by hidradenitis, then patients first develop an inflammatory purulent node in the nipple (quite painful when palpated), then the nipple swells, turns red, and after the pustule breaks through, pus begins to be released.

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Forms

Inflammation of the nipple during pregnancy and breastfeeding

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

Obvious and well-known causes of sore nipples during breastfeeding include:

• lactation-related nipple cracks (ICD 10 - O92.1) and their infection;
• injury to the nipples during feeding due to errors in latching the baby to the breast;
• lactostasis and acute lactational mastitis developing against the background of milk stagnation;
• bacterial mastitis (bacterial infection of the milk ducts);
• failure to maintain hygiene of the mammary glands during lactation.

80% of newborns have engorgement of the mammary glands, which many perceive as inflammation of the nipples in newborns. This phenomenon, according to pediatricians, despite possible discharge from the nipples, is not dangerous and passes over time, as the female sex hormones received from the mother during intrauterine development gradually leave the baby's blood. The main thing is to maintain hygiene and ensure that engorgement does not develop into inflammation - with redness and fever, characteristic of mastitis in newborns.

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Inflammation of the areola of the nipple

Inflammation around the nipple (areolitis) occurs when:

• Montgomery's periareolar glands (sebaceous glands located near the nipple) become inflamed. Possible causes of such inflammation are the "clogging" characteristic of these glands and secondary bacterial infections; the inflammation is local and very rarely causes systemic reactions.
• Zuska's disease develops, i.e. a subcutaneous abscess of the areola with a mammillary fistula (fistula). The pathogenesis of the disease is associated with the occurrence of epithelial squamous cell metaplasia, which leads to obstruction of the milk ducts. It can occur in both non-lactating women and overweight men.
• hidradenitis localized in the areola of the nipple occurs (since there are also sweat glands in the areola).
• Under the influence of Staphylococcus aureus, folliculitis (inflammation of the hair follicles of the areola) occurs.

Purulent inflammation of the areola of the nipple of hormonal origin is a diagnosis mainly for young patients. But doctors explain its occurrence in pregnant women by the fact that the size of the areolas and Montgomery glands themselves increases significantly during gestation, while the secretion of sebum, which clogs them, also increases.

Diagnostics nipple inflammation

Initially, diagnosis of nipple inflammation includes examination and palpation of the mammary glands and recording of all patient complaints.

Then, to determine an accurate diagnosis, the doctor prescribes tests; these may include a general blood test and a biochemical analysis (for hormone levels - sex and thyroid, as well as for HPV and tumor markers - if papilloma and Paget's cancer are suspected); scraping or sowing of nipple discharge for the presence of a bacterial infection, Candida fungus, HSV.

Instrumental diagnostics are used, such as X-ray of the mammary glands (mammography), ductography (examination of milk ducts), and ultrasound.

Since many symptoms of intraductal Paget's disease are similar to those of nipple inflammation or eczema, differential diagnosis is necessary. If Paget's disease is suspected, a biopsy of the nipple skin and its histological examination are prescribed.

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

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Treatment nipple inflammation

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

In case of bacterial inflammation of the nipple, antibiotics must be used (such as Ampicillin, Gentamicin, Oxacillin, Clindamycin, etc.). Tetracycline ointment, syntomycin emulsion, Clotrimazole, Levomekol ointments, etc. are also prescribed. It is recommended to wash the nipples daily with a soda solution (a teaspoon per 250 ml of warm water) or alcohol-free antiseptic solutions (Chloroxylenol, Chlorhexidine, Cetrimide).

Actovegin and Solcoseryl ointments promote healing of inflamed nipples by stimulating tissue trophism. Their use is contraindicated for pregnant and lactating women.

Inflammation of the nipples during pregnancy and breastfeeding is treated with Dexpanthenol (D-Panthenol) ointment or Bepanten Plus cream. Read more about what antibiotics can be used during breastfeeding.

Medicines for inflammation around the nipple caused by hidradenitis include oral antibiotics (Amoxicillin, Doxycycline, Lincomycin), which are taken in a course for one to two weeks. Externally, the inflammation is treated with a slightly warm solution of table salt, and ointments containing antibiotics are also applied (Mupirocin, Levomekol, etc.). Surgical treatment may be required - opening the exudative cavity and draining it. Surgery is sometimes needed to open long-term abscesses of other etiologies, 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 medications in the form of ointments such as Acyclovir, Zovirax, Bactroban, etc. Fungal infections (Candida) require oral antifungal medications and the use of Nystatin, Miconazole, Mycostatin, Clotrimazole, Terbinafine or Zalain ointments, which are not used during pregnancy and lactation.

Complications for some causes of inflammation of the juices can be in the form of scars and mutilations of the mammary gland. And life-threatening consequences include, first of all, an inflammatory reaction of the whole body to infectious inflammation of the nipple and bacterial mastitis - sepsis.

Traditional treatment of nipple inflammation and homeopathy

When using any folk treatment, you should keep in mind: the process of infectious inflammation with the formation of pus requires drug therapy, and trying to fight bacteria without antibiotics in this situation is not worth it.

However, there are many home remedies suggested for sore nipples, such as:

• If breastfeeding is the cause of your sore nipple, you can use your own breast milk, applying it to the affected nipple before and after feeding, allowing it to air dry completely.
• A warm 10-minute compress on inflamed nipples (only if there is no purulent inflammation).
• Gently massage the nipples with warm olive or almond oil (tablespoon) with the addition of two to three drops of tea tree oil, which has antiseptic properties.
• Massage the affected area with an ice cube wrapped in a sterile cloth.
• Lubricate the nipples with fresh aloe juice 4 times a day for three days (be sure to wash it off before feeding the baby - so that the baby does not get diarrhea).

It is recommended to carry out herbal treatment using basil leaves ground into a paste, which is made from a fresh plant and applied to the nipples and areola three times a day for a week. In the same way, you can use calendula flowers, which can be successfully replaced by calendula essential oil (4-5 drops) mixed with olive oil (a teaspoon or dessert spoon).

The anti-inflammatory and antimicrobial properties of chamomile help treat nipple inflammation during pregnancy and breastfeeding (compresses with chamomile decoction are made or the nipples are sprayed with it).

Homeopathy is not applicable during pregnancy and breastfeeding. In other cases, homeopaths offer patients the following remedies: Alumen, Arnica, Calcarea carbonica, Chamomilla, Graphites, Sanguinaria (for the right nipple) and Silicea (for the left nipple).

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Prevention

The best prevention of nipple inflammation is impeccable cleanliness of the nipples themselves and everything that comes into contact with them, and unconditional observance of hygiene, especially by pregnant and nursing women. Men should also pay special attention to this issue.

It is extremely important to have a complete understanding of how to properly latch the baby on when feeding even before the baby is born. During lactation, women are advised to avoid washing their nipples and the entire breast with soap every day, although high-quality baby soap can be used. It is also necessary to wear underwear made of natural fabrics, in particular, cotton. Nipples should be exposed to air and UV radiation more often. For health and its maintenance, all patients with this pathology are recommended to take more vitamin C, an active antioxidant.

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Forecast

It is clear that the prognosis of inflammation depends entirely on its cause, but for most it is favorable, except in cases where nipple inflammation concealed cancer.

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