Areolar eczema

Why are my areolas really itchy and flaky?

Eczema, a condition that causes inflammation of the skin, can affect areolas. Less commonly it will spread onto the nipple or the breast. It usually starts with itching and can become painful if the skin is opened. It can also burn. Mothers with a history of eczema may develop it on the areolas at the same time that it flares elsewhere on the body. Eczema is thought to occur when certain genetic and environmental conditions combine. Mothers who have eczema may also have allergies or asthma. It is often worse when the skin is dry. Certain irritants are known to cause eczema, including soaps, cleaners, laundry detergent, fragrances, wool, and vitamin E creams. Breastfeeding mothers can get areolar eczema when using nipple preparations or other unnecessary breast products. Eczema can be mistaken for a yeast infection.

A) Describing eczema

Dry eczema.

Eczema is the name for a group of conditions that cause the skin to become itchy, inflamed, or have a rash-like appearance. It can affect different areas of the body. In breastfeeding mothers, it can affect the skin of the areola (areolar eczema) and, if severe, it can spread onto the breast and nipple. 

Treatment includes removing possible causes, steroid skin preparations, and preventing recurrences.

Please see your health-care providers if your areolas develop a rash.

B) Appearance of areolar eczema

Dry eczema. The skin is flaky and exaggerated skin wrinkles. Inflammation has resulted in the loss of pigment cells that give the areola its dark colour.

Areolar eczema will produce skin changes. The areola may become inflamed and turn more pink or red or the skin may lose its normal colour compared with the rest of the areola and become more pale. The skin may also become flaky (dry eczema) or ooze clear, yellow fluid (wet eczema) (Barankin 2004).  

The area where the nipple meets the areola (the nipple bottom) is not usually affected as much as the rest of the areola. Eczema doesn’t like moisture, and the fold at the nipple bottom is a little damper than the rest of the areola.  

If severe, eczema can spread onto the breast and the nipple.

Eczema usually affects both areolas similarly. 

C) Timing

Dry eczema with very small cracks roughly three weeks from the start of the symptoms.

Eczema rarely starts before the baby is two weeks old, but can happen any time after that while mothers are breastfeeding. The symptoms will start gradually, over a few days.

Mothers with a history of eczema may develop areolar eczema at the same time that eczema flares elsewhere on the body.

Areolar eczema can also return after being settled (recurrent). This can happen right after stopping treatment or after a period of time without problems.

D) Type of pain

Wet eczema. Small, weeping sores are seen on the areola.

Areolar eczema usually starts with itching but mothers often feel burning as well. If not treated, it can become more painful if the skin opens and starts to ooze.

E) Causes of areolar eczema

Allergic reaction to lanolin.

While there are seven types of eczema, the two most likely to affect the breast are atopic dermatitis and contact dermatitis.

1) Atopic dermatitis

Atopic dermatitis is common in children but can happen at any age. It is a chronic condition that can come and go and is thought to be caused by an overactive immune system. Affected individuals may also have allergies or asthma and it can run in families.

Mothers who have this type of eczema on skin elsewhere are more likely to have areolar eczema. It is important to keep all eczema well under control as mothers may develop areolar eczema at the same time that other eczema flares.

2) Contact dermatitis

Contact dermatitis happens when the skin becomes irritated or inflamed after coming in contact with a substance that triggers an allergic reaction. Unlike atopic dermatitis, it doesn’t run in families and isn’t linked to other allergic conditions.

To prevent and treat areolar eczema, mothers should avoid using any nipple preparations or other unnecessary products on their breasts. Any preparation used on the nipple or areola, including creams, lotions, soaps, perfumes, and ointments should be suspect if a mother develops areolar eczema.

Examples of known irritants include:

  • Metals (nickel)
  • Soaps, cleaners, laundry detergent
  • Fragrances
  • Wool
  • Regular and purified lanolin
  • Vitamin E creams
  • Antibiotics applied to the skin
  • The baby’s solid foods

F) Other related conditions

Nipple yeast can make the diagnosis and treatment of areolar eczema more difficult:

  • It can be hard to tell eczema from nipple yeast. They affect the same general area on the breast and can look like each other.
  • Their symptoms are similar and both can itch and burn.
  • The treatment of areolar eczema with steroid preparations can increase the risk of nipple yeast.
  • The treatment of nipple yeast with antifungal creams can increase the risk of areolar eczema.
  • It is rare but possible to have both areolar eczema and nipple yeast at the same time.

Eczema elsewhere on the skin can become infected with bacteria but this is relatively uncommon with areolar eczema.

Breast cancer and nipple herpes may be misdiagnosed as eczema.

References

Barankin B, Gross MS. Nipple and areolar eczema in the breastfeeding woman. J Cutan Med Surg. 2004 Mar-Apr;8(2):126-30. Epub 2004 May 3