Hyperkeratosis of the Nipple and Areola 

  • Author: Joseph C English III, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jul 20, 2010
 

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] :

  • 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

Alternative classifications schemes have been suggested.[2, 3, 4] Upon review of the literature, a recommended classification is into (1) primary hyperkeratosis of the nipple and/or areola, which is idiopathic,[5, 6, 7, 8, 9] 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

United States

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

International

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

Mortality/Morbidity

Mortality is not associated with primary hyperkeratosis of the nipple and/or areola. The morbidity rate is low, and morbidity is primarily limited to the undesirable cosmetic results of the abnormal nipple and/or areola. The morbidity and mortality rates of secondary hyperkeratosis of the nipple and/or areola are those of the underlying diseases; thus, the rates with secondary hyperkeratosis of the nipple and/or areola may be greater than those with other types of hyperkeratosis of the nipple and/or areola.

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.[21]

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

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

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.

Specialty Editor Board

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: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, American Dermatological Association, Dermatology Foundation, Medical Dermatology Society, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

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

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and 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, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

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

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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