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Abstract
A 35-year-old female presented (Figs. 8.1 and 8.2). At the age of 13 years, she developed bilateral verrucous thickening of her areolae and nipples. Lesions were mildly pruritic. However, there was no pain, no bleeding, no discharge, no ulceration, no nipple retraction and no other skin lesion. She had no systemic symptoms and no lymphadenopathy and there was no family history of a similar disorder.
Although nevoid hyperkeratosis of the nipple and areola was initially described in 1923, there are only case reports or reviews about it; no large series have been documented to date. The clinical features of the reported cases in the literature are not uniform, and it is questioned whether nevoid hyperkeratosis of the nipple and areola is a distinct clinicopathologic entity or a clinical presentation of various dermatoses. We describe 7 cases with hyperkeratotic nevoid lesions localized on the nipple and areola with different clinical features. None of them had any other associated dermatologic or systemic disease. Histopathologic examination was performed in 6 patients. Four of them had common histopathologic features suggesting a distinct entity, namely, nevoid hyperkeratosis of the nipple and areola; 2 of them had histopathologic features consistent with seborrheic keratosis. Seborrheic keratosis presents as sharply demarcated papules or plaques, whereas nevoid hyperkeratosis of the nipple or areola presents as a plaque diffusely involving the nipple or the areola.
Background
To date, approximately 43 cases of hyperkeratosis of the nipple and areola have been reported, most of which have been sporadic.
Observation
We describe 3 patients with this dermatosis who were encountered in the outpatient clinic of the Department of Dermatology at the American University of Beirut Medical Center, Beirut, Lebanon, within a 1-year period.
Conclusion
Hyperkeratosis of the nipple and/or areola may be more common than what has been reported in the literature. We propose a revised classification for the condition.
To the Editor.—
Hyperkeratosis of the nipple and areola is a rare condition that may have nevoid features, resemble acanthosis nigricans, or be associated with ichthyosis.1,2 It is of cosmetic importance only, but a lack of response to topical therapy or treatment with retinoids3 may lead patients to seek surgery.2
Report of a Case.—
A 30-year-old woman presented with a three-year history of warty distortion of her left nipple and areola that started just after the birth of her son. The right nipple was normal, the lesion was asymptomatic, and she was otherwise well. She gave no personal or family history of warts, epidermal nevi, or ichthyosis.Examination revealed warty hyperkeratosis confined to the left nipple and areola (Fig 1), but no other abnormality. Histologic examination of the lesion confirmed the clinical diagnosis of nevoid hyperkeratosis of the nipple. Restriction enzyme analysis was performed, but no
BackgroundLeiomyoma of the nipple and areola is a rare benign neoplasm. We report the case of a patient with leiomyoma of the nipple presenting as a hyperkeratotic plaque.ObservationA 23-year-old patient presented with a five year history of a papillomatous, hyperkeratotic, painful plaque originating in her right nipple. Histological examination of a punch biopsy showed hyperkeratosis of the epidermis with dilatation of the lymphatic vessels within the dermis. Surgical excision revealed a proliferation of smooth muscle fibres, leading to diagnosis of leiomyoma.DiscussionThe clinical and histological features were initially consistent with idiopathic naevoid hyperkeratosis of areola. However, associated pain is uncommon in idiopathic lesions. This unusual feature led us to surgical excision enabling the diagnosis of leiomyoma. A hyperkeratotic lesion of the nipple may be associated with benign or malignant neoplasms, hamartoma or chronic dermatoses, or it may be idiopathic. In the present case, the hyperkeratotic lesion revealed subareolar leiomyoma. This is an uncommon clinical presentation not previously seen in medical observations, since leiomyoma usually presents as a firm, painful lump in the subareolar region.
To the Editor.— Hyperkeratosis of the nipple and areola is a rare condition. We have found a total of 35 cases published in the literature to date. Both the nipple and areola were involved in 25 cases, whereas the nipple alone was affected in 10 cases (Table). The condition is of cosmetic importance only. Treatment with topically applied retinoic acid may induce an acceptable response. Report of a Case.— A 21-year-old woman presented with pigmentation and desquamation of the right nipple (but not the areola) present since the age of 11 (menarche occurred at age 9). New lesions appeared following pregnancy at age 20, in this case affecting the left nipple but not the areola; this made breast feeding impossible. No personal or family history of warts, epidermal nevi, or ichthyosis was reported. Examination revealed warty, asymptomatic hyperkeratosis confined to both nipples, but no other anomalies (Fig 1). Histologic examination
Hyperkeratosis of the nipple and areola has been classically divided into three categories: a part of an epidermal nevus, a type associated with ichthyosis, and a nevoid form seen in young women. A case of hyperkeratosis of the nipples in a patient with adenocarcinoma of the prostate treated with diethylstilbestrol is described herein. A possible correlation between estrogens and an acquired form of this rare skin disorder is suggested.
Breast and nipple skin is commonly affected by various inflammatory and neoplastic processes. Despite this fact, many physicians are unaware of the spectrum of diseases that can involve this area. Because breast and nipple skin represents a cosmetically, sexually, and functionally important entity to most patients, awareness of these disease entities is invaluable. This article reviews the normal anatomy of the breast, cutaneous manifestations of neoplastic processes that can present in these areas, and common inflammatory diseases of the breast and nipple skin.
To date, approximately 43 cases of hyperkeratosis of the nipple and areola have been reported, most of which have been sporadic.
We describe 3 patients with this dermatosis who were encountered in the outpatient clinic of the Department of Dermatology at the American University of Beirut Medical Center, Beirut, Lebanon, within a 1-year period.
Hyperkeratosis of the nipple and/or areola may be more common than what has been reported in the literature. We propose a revised classification for the condition.
Nevoid hyperkeratosis of the nipple and areola, which is characterized by verrucous thickening and pigmentation of the nipple or areola, is a rare condition. Different therapeutic options have been used with varying results, but there is no uniformly effective treatment. We describe two patients with hyperkeratosis of the nipple and areola who responded well to topical calcipotriol ointment.