Byline: Veeranna. Shastry, Jayadev. Betkerur, P. Kushalappa
Nevoid hyperkeratosis of the nipple and areola is an unusual condition. Two female patients aged 31 and 18 years presented with chronic unilateral warty lesions of the nipple. One patient had difficulty in breastfeeding from the affected side. A skin biopsy showed acanthosis, hyperkeratosis, papillomatosis, and lymphocytic infiltrate in the dermis. There was no significant improvement with topical tretinoin cream in both the patients.
Nevoid hyperkeratosis of nipple and areola (NHNA) is a rare condition, in which the skin of the nipple and/or areola becomes diffusely thickened, hyperpigmented, and covered with filiform or papular warty excrescences. We report two female patients with this rare condition.
Case 1 A 31-year-old married woman noted a change in the appearance of the left nipple since 2 years, accompanied initially by mild itching. There was no history of discharge from the nipple. She had delivered a baby boy a year ago. Despite difficulty in breastfeeding from the affected side, she had continued to breast-feed the baby for nine months after the delivery. She was not taking estrogen preparations. She had applied topical steroids and antifungal agents without any improvement.
On examination, the left nipple showed a warty surface and mild scaling [Figure 1]. There was minimal induration, and no tenderness. There was no discharge or lymphadenopathy. There were no changes in the areola. Breast examination was normal. The right nipple was normal. A skin biopsy taken from the left nipple showed hyperkeratosis, acanthosis, papillomatosis, and keratotic plugging [Figure 2]. She was treated with topical tretinoin 0.025% cream at night, and an emollient in the morning, without any significant change at the end of one month.
Case 2 An 18-year-old unmarried female presented with a growth on her left nipple, of one year's duration. There was a history of mild itching initially, but not of...