Treating areolar eczema

How do I treat eczema on my areolas?

Mothers with areolar eczema should avoid all skin irritants that may cause eczema. There are many possibilities including: creams, lotions, ointments, and nipple products. Another may be the solid foods the baby has just begun to eat. To minimize contact with those foods, the baby’s saliva should be washed off the nipples and areolas after breastfeeding with breast milk. Steroid ointments are very effective at treating areolar eczema, but they can have side-effects for both mother and baby. They need to be washed off with breast milk before breastfeeding and should not be used for more than a few weeks. If a mother’s areolas are worse or are not normal after three weeks of treatment with a steroid preparation, they should see their health-care providers. If mothers have eczema on another part of the body, it is important to treat it. Nipple yeast can develop during treatment of areolar eczema or can mimic it.

A) Identify and remove the cause

Severe eczema spreading up the breast.

Areolar eczema can develop when mothers are breastfeeding. It produces skin changes and mothers can feel itching and pain. It may also burn. It should be treated and further episodes should be prevented.

1) Remove possible irritants

Areolar eczema may be a reaction to a product that is in contact with the breast. Mothers with areolar eczema should avoid all creams, lotions, ointments, and nipple care products that may have caused it (Barankin 2004). Even products designed for use on the breast can result in eczema. For example, our clinic has cared for two patients who reacted to purified lanolin

If your baby has just started eating solid foods, the eczema may be a reaction to those foods. To minimize contact with the baby’s foods, wash the baby’s saliva off your nipples and areolas after breastfeeding. Use expressed breast milk to wipe the saliva off with a soft, clean cloth. Breast milk contains a small amount of fat that can lubricate the areola and prevent drying. 

2) Control eczema elsewhere on the body

Some people are prone to eczema. The presence and severity of it on the areola seems to be related to its presence and severity elsewhere on the body, so it is important to keep all eczema under control.  

B) Steroid preparations

Steroid skin preparations (lotions, creams, or ointments) are very effective at treating eczema. They usually require a prescription from a health-care provider.

In general, low to moderate strength steroids are effective as the areolar skin is thin and responds well to steroid preparations. The strength depends on the severity of the eczema.

We have found that mothers report ointments most soothing and prefer these over lotions and creams. Ointments should be used if the skin is open or weeping.

We have found that areolar eczema is settled within three weeks. Steroid preparations can have side-effects in both mother and baby and should not be used for more than a few weeks.

If your areolas are getting worse or are not normal after three weeks of treatment with a steroid preparation, stop it and please see your health-care providers. Some individuals can be allergic to steroid skin preparations or may have other problems that have not been diagnosed.

C) Infection

1) Nipple yeast

Nipple yeast can make the diagnosis of areolar eczema more difficult for a number of reasons. It can also complicate treatment:

  • 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.

2) Bacterial infection

Eczema can break the skin and allow bacteria to enter and cause infection (Park 2018; Pimentel 2018). This can spread to the breast causing mastitis. Fortunately, this is very rare.

D) Preventing recurrences

Areolar eczema can return (flare-up) right after treatment or after a problem-free period. This can be called recurrent eczema.

Mothers should eliminate all possible causes of areolar eczema. They should avoid using any nipple preparations or other unnecessary products on their breasts.

Recurrent areolar eczema is more common if the mother has a history of eczema elsewhere on the body. Areolar eczema sometimes flares up when eczema is active on other parts of the body. It is important to control any eczema.  

To keep eczema from coming back, mothers may need a small amount of very low-strength steroid skin preparation regularly or occasionally. However, there are risks with the long-term use of steroid preparations.

If the rash recurs, mothers should ensure that they have the right diagnosis. For example, breast cancer can mimic areolar eczema.

References

Barankin B, Gross, MS. Nipple and areolar eczema in the breastfeeding woman. J Cutan Med Surg, 2004. 8(2): p. 126-30
 
Park SM, Choi WS, Yoon Y, et al. Breast abscess caused by Staphylococcus aureus in 2 adolescent girls with atopic dermatitis. Korean J Pediatr. 2018 Jun;61(6):200-204
 
Pimentel MA, Haemel AK. Recurrent breast cellulitis from a nipple fissure. JAAD Case Rep. 2018 Mar 2;4(3):251-252