Correlation of nipple eczema in pregnancy with atopic dermatitis in Northern India: a study of 100 cases

Abstract

BackgroundNipple eczema is a less common presentation of atopic dermatitis. No studies in the literature have correlated nipple eczema in pregnancy as a manifestation of atopic dermatitis.ObjectiveTo evaluate whether nipple eczema presenting in pregnancy is a manifestation of atopic dermatitis.MethodsThis was a prospective observational study including 100 women who presented with nipple eczema for the first time during pregnancy. The exclusion criteria were any patient with previous history of nipple eczema, those already on oral or topical treatment for atopic dermatitis or nipple eczema, and other disorders mimicking eczema. Patients were divided into two groups ‒ nipple eczema with atopic dermatitis and without atopic dermatitis. Demographic data, clinical features, total leukocyte count, differential leukocyte count, absolute eosinophil counts, and serum IgE levels were compared between the two groups to detect association between nipple eczema in pregnancy and atopic dermatitis.ResultsOut of 100 patients, 39 were diagnosed with atopic dermatitis, whereas 61 were ruled out to have any features suggestive of atopic dermatitis. There were no statistically significant differences in mean age, mean duration of symptoms, and serum IgE levels. In patients with atopic dermatitis, bilateral symptoms were noted more commonly than in patients without the disease, but this was statistically insignificant.Study limitationsLack of long term follow-up and no large studies in literature to compare results.ConclusionNipple eczema in pregnancy follows a similar pattern as in other age groups. The clinical profile of patients is similar in cases with and without atopic dermatitis.

Description of Hanifin-Rajka Criteria and Skin Hydration in Adult Patients with Mild-Moderate Atopic Dermatitis at Tertiary Hospital

“…Even though unilateral nipple eczema is present, it is more associated with other differential diagnoses such as irritant contact dermatitis, skin infections, and Paget's disease. 17,18 It is known that the nipple has a similar outer layer to the skin, a stratified squamous epithelium. 19 In AD, barrier disruption, immunological derangement, lipid disruption, and loss of epithelial integrity cause loss of skin function as a physical barrier.…”

“…20 Exposure to allergens such as clothing (wool), bacteria from unsterile breast pumps, and blisters resulting from incorrect attachment of a breastfeeding baby to bacteria can trigger itching and nipple eczema. 18,21 Interestingly, there are several case reports of AD patients with stress triggers. First, adolescents have nipple eczema, with triggers of stress due to the nipple eczema that they experience, making the nipple eczema itchy and widespread.…”

Nipple eczema: A systematic review and practical recommendations

“…Atopic nipple eczema typically affects both nipples, frequently extending to the adjacent breast; nevertheless, cases of unilateral nipple AD have been described, especially in children 56,57 …”

“…55 Atopic nipple eczema typically affects both nipples, frequently extending to the adjacent breast; nevertheless, cases of unilateral nipple AD have been described, especially in children. 56,57 Atopic nipple eczema can be provoked by irritant topicals, friction with clothing, but also breastfeeding. 58 Actually, it is thought that half of the patients with nursing induced nipple eczema are in fact atopic.…”

Th2 shift in pregnancy and labor: An immunological perspective to elucidate the pathogenesis onset of atopy

“…So far, it is not always clear whether allergic contact dermatitis risk is likely to increase with multiparity. Moreover, mothers with atopic predisposition are more likely to develop nipple dermatitis during breastfeeding, 14 and it is presumed that atopic predisposition is likely to cause skin symptoms during pregnancy and after childbirth. Even in daily clinical practice, the course of the Th2 shift varies from patient to patient during pregnancy and the postpartum period, and the regulatory mechanism of switching and turning off the Th2 shift during pregnancy requires further investigation.…”