A crusty nipple describes a symptom where the nipple area appears dry, flaky, or has scabs. While often concerning, this condition is frequently attributed to benign and easily treatable causes. Understanding the various reasons behind this symptom can help in determining whether self-care is sufficient or if medical attention is necessary.
Everyday Explanations
Environmental conditions, such as cold or dry climates, can cause general skin dryness, which may extend to the delicate nipple area. This dryness can result in flaking or a crusty texture. Moisturizing the skin regularly can often alleviate this discomfort.
Friction and irritation are also frequent culprits. Tight clothing, ill-fitting bras, or vigorous towel drying can rub against the nipples, leading to irritation, dryness, and subsequent crusting. Athletes, particularly runners, sometimes experience “jogger’s nipple” due to constant rubbing against clothing. Choosing comfortable, breathable fabrics and ensuring proper bra fit can help prevent this irritation.
For individuals who are breastfeeding, dried breast milk is a very common cause of nipple crusting. Leftover milk can dry on the skin, forming a white or yellowish crust in the nipple’s crevices. While generally harmless, regular gentle cleaning with warm water after feeding can prevent buildup and potential irritation. Beyond lactation, normal nipple discharge, which can occur outside of breastfeeding, might also dry and form a crust.
Minor trauma to the nipple area can also cause temporary crusting as the skin heals. Small cuts, scratches, or even overly aggressive cleaning can lead to superficial damage. The body’s natural healing process involves forming a protective crust or scab over the injured area. Once the skin fully repairs itself, this crust typically resolves on its own.
Skin Conditions and Infections
Beyond everyday irritations, several medical skin conditions and infections can manifest as a crusty nipple. Eczema, also known as dermatitis, is a common inflammatory skin condition that can affect the nipples. This can present as an itchy, red, scaly rash, sometimes with oozing or crusting. Both atopic dermatitis and contact dermatitis, an allergic reaction to substances like soaps or detergents, can cause these symptoms.
Psoriasis, an autoimmune condition that accelerates skin cell growth, rarely appears on the nipples but can cause thick, scaly plaques that might be itchy, dry, or painful. When it does occur, it often presents as dry, discolored patches with white scales. These patches can sometimes crack and bleed, leading to further discomfort.
Fungal infections, such as thrush (candidiasis), can affect the nipples, particularly in breastfeeding individuals. This yeast infection can cause nipples to appear bright pink, with the areola becoming reddened, dry, or flaky. Symptoms often include burning, stinging, or deep aching pain in the nipples and breasts, which may persist between feeds.
Bacterial infections can also lead to crusting, especially if there are minor breaks in the skin. Conditions like cellulitis, where bacteria enter through cracks or damaged skin, can cause redness, swelling, warmth, and pain, sometimes accompanied by pus-like discharge or crusting. These infections can sometimes be severe and may require antibiotic treatment.
When to Seek Medical Evaluation
While many causes of a crusty nipple are benign, certain signs warrant a medical evaluation to rule out more serious conditions. It is advisable to consult a healthcare professional if the crusting persists despite self-care measures, or if it is accompanied by other concerning symptoms. These red flag symptoms include persistent pain, itching, or burning that does not resolve.
Seek medical attention for:
Changes in nipple or breast appearance (new redness, warmth, swelling).
Unusual discharge (bloody, clear, yellowish, or unusual color).
Changes in nipple shape (flattening or inversion).
A new lump in the breast or under the arm.
Unilateral crusting (affecting only one nipple).
Symptoms that do not improve over time.
A less common but serious cause to consider is Paget’s disease of the nipple, a rare form of breast cancer. This condition often presents with eczema-like changes to the nipple and areola, including crusting, scaling, redness, and itching. While rare, particularly affecting 1% to 4% of breast cancer cases, it is important to differentiate it from benign skin conditions like eczema, as early diagnosis leads to better outcomes.
During a medical evaluation, a doctor will typically perform a physical examination of the breast and nipple, ask about medical history, and inquire about specific symptoms. Depending on the findings, diagnostic tests may be recommended, which could include a skin biopsy of the affected area, a mammogram, or an ultrasound. Treatment for a crusty nipple depends entirely on the underlying cause. Options can range from topical creams for conditions like eczema, antifungal medications for yeast infections, or antibiotics for bacterial infections. For more serious conditions like Paget’s disease, further specialized evaluation and treatment are necessary.