Skin conditions such as eczema or dermatitis may occur on the nipple and the areola, the flat coloured part around the nipple. These problems are more common in women who tend to be allergic (eg. have known eczema, asthma or hay-fever), or who are pregnant or breastfeeding. Irritant contact dermatitis is caused by inflammation of the skin by products such as shampoos, soap, washing detergents or chemicals. Allergic contact dermatitis is a true allergy to a product used on the skin.

With any of these causes, a rash is seen on the nipple or areola which may be dry or weepy. The rash is usually itchy and may be on one or both breasts. There may be an associated burning pain especially if breastfeeding. In breastfeeding women the symptoms often occur around the time of infant teething or the introduction of solids.

Treatment
Topical treatment:

• Prescription steroid ointments: Elocon ointment or Advantan fatty ointment 1-2x daily, applied to the affected area only, for 7 days
• If breastfeeding, apply the ointment sparingly after a feed
• After 7 days, switch to 1% hydrocortisone ointment daily. Continue the treatment for a further 3 days after there is no longer any visible rash
• Be consistent for the best results!

General Measures

• Avoid soaps and shampoos on the nipple area
• Rinse breasts well, especially after swimming in chlorine
• Avoid hot and long showers
• Do not use any moisturisers other than unfragranced sorbolene on the nipples
• Avoid perfumes and fragranced body products on the breasts
• Avoid padded bras if possible, as the foam padding traps particulate washing powders which are highly irritative to skin.
• Handwash bras (remember sports bras!) with a simple non-particulate soap (eg. Simple soap, Cetaphil, hypoallergenic wool-wash); and avoid excessive soap in cup area of the bra. Rinse bras thoroughly and dry indoors (away from pollens etc). Do not tumble-dry.

Eczema or dermatitis may cause weeping and crusting on the nipple. However, if at any stage you see true nipple discharge coming out of a single duct on the nipple, or if the skin changes on your nipple do not get better with the above treatment, please return to Sydney Breast Clinic for prompt review as this may indicate a different condition.