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Hyperkeratosis of the Nipple and Areola

  • Author: Ivan D Camacho, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Nov 09, 2015
 

Background

Hyperkeratosis of the nipple and/or areola (HNA) is defined as excessive keratinization of the nipple and/or areola. Hyperkeratosis of the nipple and/or areola is characterized by hyperpigmented, verrucous or filiform, keratotic thickening of the nipple and/or areola, with a papillomatosis or velvety sensation to touch. Hyperkeratosis of the nipple and/or areola has classically been classified into the following 3 subsets[1, 2, 3] :

  • Type I - hyperkeratosis of the nipple and/or areola due to the extension of an epidermal nevus
  • Type II - hyperkeratosis of the nipple and/or areola in conjunction with disseminated dermatoses
  • Type III - Nevoid hyperkeratosis of the nipple and/or areola

Perez-Izquierdo et al suggested an alternative classification, distinguishing 2 types: (1) those that are idiopathic or nevoid and (2) those that are secondary to other conditions.[4] Others have advocated that the term “nevoid” be replaced by “idiopathic”.[5, 6] Upon review of the literature, a recommended classification is into (1) primary hyperkeratosis of the nipple and/or areola, which is idiopathic,[7, 8, 9, 10, 11] and (2) secondary hyperkeratosis of the nipple and/or areola, which is associated with the following:

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Pathophysiology

The pathophysiology of hyperkeratosis of the nipple and/or areola is unknown.

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Epidemiology

Frequency

Hyperkeratosis of the nipple and/or areola is rare, and currently no domestic or international incidence rates have been documented in the literature.

Race

Hyperkeratosis of the nipple and/or areola has no reported racial predilection.

Sex

Hyperkeratosis of the nipple and/or areola is more common in females than in males. In a study of 45 primary hyperkeratosis of the nipple and/or areola patients 80% were females.[23]

Age

In females, hyperkeratosis of the nipple and/or areola most commonly occurs in those aged 10-40 years. Males with nevoid hyperkeratosis of the nipple and/or areola are often older than females, but no specific age distribution is reported.

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Contributor Information and Disclosures
Author

Ivan D Camacho, MD Dermatologist, Private Practice; Voluntary Assistant Professor of Dermatology, Department of Dermatology and Cutaneous Surgery, University of Miami, Leonard M Miller School of Medicine

Ivan D Camacho, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Florida Medical Association, International Society of Dermatology, Women's Dermatologic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Joshua R Freedman, MD, MS Resident Physician, Department of Dermatology and Cutaneous Surgery, Jackson Memorial Hospital, University of Miami, Leonard M Miller School of Medicine

Joshua R Freedman, MD, MS is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Edward F Chan, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Kathryn Schwarzenberger, MD Associate Professor of Medicine, Division of Dermatology, University of Vermont College of Medicine; Consulting Staff, Division of Dermatology, Fletcher Allen Health Care

Kathryn Schwarzenberger, MD is a member of the following medical societies: Women's Dermatologic Society, American Contact Dermatitis Society, Medical Dermatology Society, Dermatology Foundation, Alpha Omega Alpha, American Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

Joseph C English III, MD Clinical Vice-Chairman for Quality and Innovation, Professor of Dermatology, Department of Dermatology, University of Pittsburgh School of Medicine

Joseph C English III, MD is a member of the following medical societies: American Academy of Dermatology and American Medical Association

Disclosure: Nothing to disclose.

References
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An adult male with bilateral primary hyperkeratosis of the nipple and areola
A close-up of the patient's right nipple/areola complex.
A close up of the patient's nipple/areola complex.
 
 
 
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