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Pregnancy-associated hyperkeratosis of nipple symptomatic, persisted postpartum

Pregnancy-associated hyperkeratosis of the nipple is a distinctive disorder that can be symptomatic and persist postpartum, according to study results.

In a clinicopathologic analysis, researchers identified 25 women (aged 23 to 42 years) with pregnancy-associated hyperkeratosis of the nipple between 2007 and 2012.

“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,” the researchers wrote.

Bilateral lesions, predominantly located on the top of the nipple, developed in the second or third trimester in 20 patients and in the first trimester in three others. Physicians observed the lesions on the remaining two patients postpartum, but the women noticed onset during the third trimester. Lesions persisted postpartum for 22 patients.

Seventeen patients had lesions that caused tenderness or discomfort, pruritus, sensitivity to touch, and/or breastfeeding discomfort. Symptomatic aggravation during pregnancy or breastfeeding was experienced by nine patients. Conspicuous orthokeratotic hyperkeratosis was a histopathologic feature, while papillomatosis and acanthosis were mild or absent.

The disorder “may represent a physiologic change during pregnancy,” the researchers said, that is “supported by onset during pregnancy or in the immediate postpartum period and worsening with subsequent pregnancies, which suggest an effect of high estrogen levels.”

“Because the lesions can be persistent and symptomatic, physicians should be familiar with pregnancy-associated hyperkeratosis of the nipple and able to counsel the patient appropriately on prognosis and treatment,” the researchers concluded.