0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 50.17.174.94. Please contact the publisher to request reinstatement.
Observation |

Pregnancy-Associated Hyperkeratosis of the Nipple:  A Report of 25 Cases

H. William Higgins, MD; Jennifer Jenkins, MD, MPH; Thomas D. Horn, MD, MBA; George Kroumpouzos, MD, PhD
JAMA Dermatol. 2013;149(6):722-726. doi:10.1001/jamadermatol.2013.128.
Text Size: A A A
Published online

Importance Reported physiologic nipple changes in pregnancy do not include hyperkeratosis and are expected to resolve or improve post partum. Hyperkeratosis of the nipple and/or areola can develop in the context of inflammatory diseases (such as atopic dermatitis), in acanthosis nigricans, as an extension of epidermal nevus, after estrogen treatment, and/or in nevoid hyperkeratosis of the nipple and areola. We performed a clinicopathologic analysis of cases of pregnancy-associated nipple hyperkeratosis.

Observations Twenty-five cases of pregnancy-associated nipple hyperkeratosis identified during a 5-year period (January 1, 2007, through December 31, 2012) are reported. The lesions were bilateral and involved predominantly the top of the nipple. Lesions were symptomatic in 17 patients (68%), causing tenderness or discomfort, pruritus, sensitivity to touch, and/or discomfort with breastfeeding. Nine patients (36%) experienced symptomatic aggravation only during pregnancy or breastfeeding. The lesions persisted post partum in 22 patients (88%). Histopathologic features were conspicuous orthokeratotic hyperkeratosis, with papillomatosis and acanthosis being mild or absent.

Conclusions and Relevance Pregnancy-associated hyperkeratosis of the nipple can be symptomatic and persist post partum. It may represent a physiologic change of pregnancy. The characteristic clinicopathologic features of this disorder allow differentiation from nevoid hyperkeratosis of the nipple and areola. We suggest that this distinctive clinicopathologic entity be called pregnancy-associated hyperkeratosis of the nipple.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Figures

Place holder to copy figure label and caption
Graphic Jump Location

Figure 1. Nipple lesions. A, Bilateral, symmetric distribution. B, Focal involvement of the top of the nipple. C, Involvement of the entire top of the nipple and mild erythema. D, Tan to mildly pigmented, warty papules. E, Desquamation. The focal involvement of the apex of the nipple in B and C is not milk.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 2. Prominent orthokeratotic hyperkeratosis. A, Biopsy specimen (case shown in Figure 1B) shows prominent orthokeratotic hyperkeratosis and absence of epidermal hyperplasia and papillomatosis (hematoxylin-eosin, original magnification ×10). B, Biopsy specimen (case shown in Figure 1D) shows moderate hyperkeratosis with mild papillomatosis (hematoxylin-eosin, original magnification ×10). Inset shows detached section of overlying stratum corneum demonstrating conspicuous hyperkeratosis. A and B, A mild lymphohistiocytic infiltrate and dilated capillaries in papillary dermis are also shown. C, Histopathologic features of hyperkeratosis of the nipple and areola, such as marked elongation of rete ridges, ramifying epidermal hyperplasia, and conspicuous papillomatosis, are shown for comparison (hematoxylin-eosin, original magnification ×10). These features were not present in our cases.

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles
Jobs
JAMAevidence.com

The Rational Clinical Examination
Make the Diagnosis: Early Pregnancy

The Rational Clinical Examination
Original Article: Is This Patient Pregnant?

brightcove.createExperiences();