Hyperkeratosis of the Nipple and Areola Treatment & Management

Updated: May 02, 2017
  • Author: Rabindranath Nambi, MD; Chief Editor: Dirk M Elston, MD  more...
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Approach Considerations

The clinical course of primary hyperkeratosis of the nipple and/or areola (HNA) is variable and often unpredictable. Many treatment modalities for primary hyperkeratosis of the nipple and/or areola have been used; however, the results of most are anecdotal and not verified in randomized, placebo-controlled clinical trials. In addition, reported results vary among individual patients and with various medications.

Surgery should be considered in cases in which the response to medical therapy is inadequate, for cosmetic reasons, and if there is an indication for concomitant surgery of the breast. [36]

Reported treatments of nevoid hyperkeratosis of the nipple and/or areola include the following:

  • Lactic acid 12% cream [37]

  • Salicylic acid gel 6% [7]

  • Topical tretinoin [38, 39, 40]

  • Topical calcipotriol [9, 41]

  • Low-dose acitretin and topical calcipotriol [42]

  • Cryotherapy [8, 15, 26, 43, 44]

  • Shave or surgical excision of involved portion [45, 46]

  • Surgical areola removal and skin graft reconstruction [47, 48, 36]

  • Carbon dioxide laser removal [49]

  • Radiofrequency surgery [50, 51, 52]

  • Curettage [22]

Therapeutic options for secondary hyperkeratosis of the nipple and/or areola consist of the treatment options for the underlying dermatologic condition. [53]



In some cases, consultation with a plastic surgeon may be appropriate. [46]


Long-Term Monitoring

The follow-up care for patients with primary hyperkeratosis of the nipple and/or areola (HNA) is based on the response to therapy and any change in the clinical presentation. A follow-up examination at 3-6 months after the initiation of therapy is reasonable. The patient should be instructed to return to the clinic immediately if any nipple discharge, nipple retraction, or palpable mass is present.

Monthly breast examinations are important for breast cancer surveillance, and they are mandatory for all patients with hyperkeratosis of the nipple and/or areola, especially if the disease is unilateral. Patients should be cautioned and educated not to attribute any changes in their breasts to the associated hyperkeratosis of the nipple and/or areola.