Pediatric Dermatology Consult

What's the diagnosis?

Publish date: January 14, 2021

A 12-year-old boy presents to the dermatology clinic with a 1-month history of crusting and watery sticky drainage from the left nipple. Given concern for a possible skin infection, the patient was initially treated with mupirocin ointment for several weeks but without improvement. The affected area is sometimes itchy but not painful. He reports no prior history of similar problems.

On physical exam, he is noted to have an eczematous left nipple with edema, xerosis, and scaling overlying the entire areola. There is no evidence of visible discharge, pustules, or honey-colored crusts in the area. The extensor surfaces of his arms bilaterally have skin-colored follicular papules, and his antecubital fossa display erythematous scaling plaques with mild lichenification and excoriations.

What is your diagnosis?

Impetigo

Gynecomastia

Scabies

Nipple eczema

Allergic contact dermatitis

Treatment

Topical corticosteroids are first-line treatment for treating nipple eczema. Low-potency topical steroids can be used for maintenance and mild eczema while more potent steroids are useful for more severe cases. In addition to topical medication therapy, frequent emollient use to protect the skin barrier and the elimination of any irritants are essential to a successful treatment course. Unilateral nipple eczema can also be secondary to inadequate treatment of AD, demonstrating the importance of addressing the underlying AD with therapy.3

Our patient was diagnosed with nipple eczema based on clinical presentation of an eczematous left nipple in the setting of active atopic dermatitis and minimal improvement on topical antibiotic. He was started on a 3-week course of fluocinonide 0.05% topical ointment (a potent topical corticosteroid) twice daily for 2 weeks with plans to transition to triamcinolone 0.1% topical ointment several times a week.

Ms. Park is a pediatric dermatology research associate in the division of pediatric and adolescent dermatology, University of California, San Diego, and Rady Children’s Hospital, San Diego. Dr. Eichenfield is vice chair of the department of dermatology and professor of dermatology and pediatrics at the University of California, San Diego, and Rady Children’s Hospital. Neither Ms. Park nor Dr. Eichenfield have any relevant financial disclosures.

References

1. Pediatr Dermatol. 2005;22(1):64-6.

2. Am J Dermatopathol. 2015;37(4):284-8.

3. Pediatr Dermatol. 2015;32(5):718-22.

4. J Cutan Med Surg. 2004;8(2):126-30.

5. Pediatr Dermatol. 2012;29(5):580-3.

6. Dermatologica. 1988;177(6):360-4.

7. Ann Dermatol. 2014;26(3):413-4.

8. BMJ Case Rep. 2020;13(8).

9. J Am Acad Dermatol. 2019;80(6):1483-94.

10. Pediatr Endocrinol Rev. 2017;14(4):371-7.

11. JAMA. 2010;304(9):953.

12. JAMA. 2018;320(6):612.

Pages

Next Article:

Dupilumab curbed itch intensity, frequency in children with severe eczema