The nipple is an especially sensitive area. Common problems are discussed briefly
PAIN IN NIPPLES WHILE NURSING Most Common while nursing
Cracked or Sore Nipples : This occurs in as many as 17 percent of women in the first few weeks after giving birth. Typically there is a small erosion or crack on the nipple. The pain can be severe.
Management: Oral antibiotics both provide the best relief and reduced the chance of developing mastitis. Good nipple hygiene is also imperative in preventing this distressing condition.
Infection usually resulting from Candida (a fungus that causes yeast).The involved nipples are mildly inflamed and tender to the touch.
Management: Easily treated with a topical antifungal oral gel which is applied both to the nipple and baby’s mouth.
NIPPLE DISCHARGE Most common complaint
Most women do have some amount of discharge or fluid when their breasts are squeezed. This is normal. At different life periods discharge can be greater such a at puberty and at menopause. Some women are more prone to lots of discharge. This is often due to increased Prolactin levels. Increased Prolactin levels can be found in women on birth control pills, anti-hypertensives, or strong tranquilizers.
The color of the discharge can vary—gray, green, and brown as well as white.
Inverted nipples can sometimes get dirt and dried-up sweat trapped in them. This can be confused with discharge.
When Should You Worry?
When nipple discharge is spontaneous, persistent, and only on one side it needs to be evaluated.
It could be due to:
1. Intraductal papilloma: A little wart-like growth on the lining of the duct. It gets eroded and bleeds, creating a bloody discharge. It’s benign but it needs to be removed to make sure that’s what it is.
2. Intraductal papillomatosis: Instead of one wart, there are many little warts.
3. Intraductal carcinoma in situ (DCIS): This is a precancerous condition that clogs up the duct.
4. Cancer: Rarely cause discharge. Less than 10% of all spontaneous unilateral bloody discharges are cancerous. But it’s important to have it checked.
Relationship between Cancer and Patient's Age:
Incidence of cancer in patients with discharge increases with increasing age.
32 % of patients over 60 the discharge are likely to have cancer.
10% of patients between 40-60 are likely to have cancer.
Only 3% of patients less than 40 are likely to have cancer.
Usual Management in case of Nipple Discharge.
Check for blood in the discharge
Pap smear for the discharge
Locate the duct causing discharge. This can be by physical examination along with Ultrasound and Mammogram.
GALACTORRHOEA - Excessive or spontaneous milk flow.
This is spontaneous, on both sides and milky in patients who are not breastfeeding and haven’t been in the past year. Often accompanied by amenorrhoea ( failure to get the period).
Essentially associated with hormonal problems. It occurs because something is increasing the prolactin levels. Major tranquilizers, marijuana consumption, or high estrogen doses can also cause galactorrhoea. Sometimes can be due to a small tumor in the brain in the pituitary gland.
Management: Usually can be treated by medication.
If both nipples itch it is usually some local cause such as
Dry skin on the nipples.
Allergies related to bra material or to the detergent it’s washed in.
Pubescent girls with growing breasts often experience itching as the skin stretches.
Management: Local application of Calamine lotion or other anti-itch medication can help.
ECZEMA OF THE NIPPLE
Usually occurs on both nipples. Patients have history of eczema.
Management: Responds to standard eczema treatment.
Eczema of the Nipple can be confused with Paget’s disease.
Paget's Disease is a form of cancer. It is found on only one nipple. It looks like an open sore area and itches. It does not respond to standard eczema medication.
Most infections and irritations of the nipple are benign.
If they appear, they need to be checked out for 2 reasons.
To get relief and to make certain they are just infections.