Nipple crust refers to dried material that can accumulate on the nipple or surrounding areola. This accumulation often consists of bodily secretions, skin cells, or other substances that have dried and hardened. While discovering crust on the nipple can sometimes be a cause for concern, it is a common occurrence that is frequently benign and easily explained by everyday factors. However, in some instances, nipple crust can indicate an underlying medical condition that may require attention. Understanding the potential causes helps determine when to seek medical advice.
Everyday Reasons for Nipple Crust
Many common and harmless factors can lead to nipple crust. The skin naturally produces oils (sebum) and sheds skin cells, which can dry and accumulate on the nipple surface, forming a light crust. This process typically resolves with routine hygiene practices.
Sweat is another frequent contributor, especially during physical activity or in warm environments. As sweat evaporates, it leaves behind salt and other residues that dry into a visible, sometimes flaky, layer. For individuals who are breastfeeding or have recently stopped lactating, dried breast milk is a very common cause. Small amounts of milk can leak and then dry on the nipple, creating a film that may vary in color and texture.
Even friction from clothing can sometimes contribute by irritating the skin. Maintaining regular personal hygiene, such as gentle washing with mild soap and water, usually helps to remove these types of crusts. These everyday reasons typically do not involve other symptoms like pain, redness, or itching, distinguishing them from more concerning causes.
Underlying Skin Conditions and Infections
Beyond everyday occurrences, certain skin conditions and infections can manifest as nipple crusting. Eczema, a common inflammatory skin condition, can affect the nipple and areola, leading to dry, itchy, and sometimes crusted patches. This can include atopic dermatitis or contact dermatitis. Psoriasis, another chronic autoimmune condition, can also cause scaly, red patches that may crust over on the nipples, though this is less common than eczema in this specific area.
Infections, both bacterial and fungal, are additional medical causes for nipple crust. Bacterial infections, such as impetigo, can cause red sores that quickly rupture and form honey-colored crusts. These infections often result from bacteria entering small breaks in the skin. Fungal infections, particularly candidiasis (yeast infection), can also affect the nipple area, leading to redness, itching, and sometimes a white, flaky, or crusted appearance, especially in warm, moist environments.
These conditions often present with additional symptoms that help differentiate them from benign crusting. Patients may experience persistent itching, burning, pain, significant redness, swelling, or a rash that extends beyond the nipple. The crusting associated with these conditions tends to be more persistent and may not resolve with simple hygiene measures. Addressing these underlying conditions usually requires specific medical treatments, such as topical creams or oral medications, to alleviate the symptoms and clear the infection or inflammation.
Symptoms Warranting Medical Attention
While many instances of nipple crust are harmless, certain accompanying symptoms can signal a more serious underlying issue that requires prompt medical evaluation.
- Persistent crusting that does not resolve with regular hygiene or worsens over time.
- Bleeding from the nipple or crust that appears bloody.
- Nipple discharge, particularly if it is bloody, clear, or any color other than milky.
- Changes in the shape of the nipple, such as a newly inverted nipple or one that appears flattened.
- Alterations in the skin around the nipple or on the breast itself, including dimpling, puckering, persistent redness, scaling, or ulceration.
- Skin thickening or a texture resembling an orange peel, often referred to as peau d’orange.
- Severe pain in the nipple or breast that is unexplained and persistent.
- Discovery of a new lump or mass in the breast tissue.
These signs, especially when present alongside nipple crusting, suggest the need for a thorough diagnostic workup.
When to Consult a Doctor and What to Expect
If you notice persistent nipple crusting that does not improve with basic hygiene, or if it is accompanied by any of the concerning symptoms mentioned, consulting a healthcare professional is advisable. A general practitioner is a good first point of contact, and they can refer you to a specialist, such as a dermatologist or a breast surgeon, if needed.
The doctor will typically begin by taking a detailed medical history, asking about the duration of the crusting, any associated symptoms, and your overall health. A physical examination of the nipple and breast will then be performed to assess the appearance of the crust, the surrounding skin, and to check for any lumps or other abnormalities.
Depending on the initial findings, the doctor may recommend further diagnostic tests. These could include a skin biopsy, where a small tissue sample is taken from the crusted area for microscopic examination to identify specific skin conditions or cellular changes. Imaging tests, such as a mammogram or ultrasound of the breast, might also be ordered to visualize the breast tissue and identify any underlying masses or structural changes. Once a diagnosis is made, treatment will be tailored to the specific cause. This could range from prescription creams for inflammatory skin conditions like eczema, to antibiotics or antifungals for infections, or more extensive interventions if a serious condition is identified.