Skin conditions such as eczema or dermatitis may occur on the nipple and areola of pregnant and breastfeeding women. Management approaches are similar to eczema and dermatitis on other parts of the body.
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History
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Women will usually give a history of an itchy rash on the areola of one or both breasts. They may describe a burning pain, especially while breastfeeding. The onset of symptoms occur more commonly at 5 or 6 months postpartum and are associated with infant teething or the introduction of solids.
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On examination
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Eczema of the nipple appears as a well demarcated erythematous rash, which may be dry and scaly or weepy with vesicles.
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Aetiology
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Endogenous atopic eczema: women may have a history of atopic eczema or asthma or hayfever.
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Irritant contact dermatitis: this type of dermatitis is caused by irritation of the skin by products such as creams, gels, soap, detergent or chemicals (e.g. chlorine).
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Allergic contact dermatitis: A delayed hypersensitivity to an allergen in a product used on the skin (eg non purified lanolin).
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Management and treatment
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General measures
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- avoid soap or shampoo on the nipples
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- avoid using any products on the nipples except for ultra-purified lanolin
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- moisturise nipples with ultra-purified lanolin or sorbolene after shower or bath.
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Treatment
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Topical corticosteroids are the main method of treatment. They should be applied sparingly after a breastfeed. Ointment is preferred as it will be absorbed before the next breastfeed
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Potent corticosteroids may be used for up to 7 days:
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- Mometasone furoate (Elocon ) ointment once daily or
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- Methylprednisolone aceponate (Advantan ) ointment once daily
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If the eczema appears to be infected, antibiotic treatment may be necessary in addition to the corticosteroid (eg Bactroban ointment).
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References
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Amir L. Eczema of the nipple and breast: a case report. J Hum Lact 1993; 9: 173-75.
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Barankin B, Gross MS. Nipple and areolar eczema in the breastfeeding woman. J Cutan Med Surg. 2004; 8:126-30.
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Drugs and Breastfeeding. Pharmacy Department, The Royal Women's Hospital 2004.
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Royal Women's Hospital Clinical Practice Guidelines (CPGs) are intended to provide guidance to health care professionals, based on a thorough evaluation of research evidence, on the practical assessment and management of specific clinical issues or situations. The guidelines allow some flexibility on the part of the health care professional based on the needs of the specific patient for whom they are caring.
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