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LETTER TO EDITOR
Year : 2021  |  Volume : 22  |  Issue : 2  |  Page : 189-190

Nipple eczema-rare minor criterion for diagnosis of atopic dermatitis in infants


1 In Skin Clinic, Vadodara, Gujarat, India
2 Department of Dermatology, BJ Wadia Hospital for Children, Parel, Mumbai, Maharashtra, India

Date of Submission06-Dec-2020
Date of Decision25-Dec-2020
Date of Acceptance03-Jan-2021
Date of Web Publication31-Mar-2021

Correspondence Address:
Shyam Bhanushankar Verma
In Skin Clinic, Productivity Main Road, Vadodara - 390 020, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.ijpd_174_20

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How to cite this article:
Verma SB, Vasani R. Nipple eczema-rare minor criterion for diagnosis of atopic dermatitis in infants. Indian J Paediatr Dermatol 2021;22:189-90

How to cite this URL:
Verma SB, Vasani R. Nipple eczema-rare minor criterion for diagnosis of atopic dermatitis in infants. Indian J Paediatr Dermatol [serial online] 2021 [cited 2021 Apr 18];22:189-90. Available from: https://www.ijpd.in/text.asp?2021/22/2/189/312820



A 7-month-old baby girl was brought to one of the authors (SV) for an eruption over both nipples and areolae for the past 10 days. The parents said that she frequently rubbed the area with her fingers and appeared uncomfortable while doing so. There was no history of oozing. The parents said that she had a similar episode when she was 5 months old which responded to an emollient and mometasone cream applied for a week. A detailed history did not reveal anything suggestive of an irritant or allergic contact dermatitis. There was no history of any drug intake and she showed no signs suggestive of scabies. She had a strong history of atopy in the family. Her father had frequent seasonal bouts of sneezing. Her paternal grandparents had localized eczema of the feet and asthma respectively and her first cousin from maternal side had childhood eczema. On examination, she was a healthy infant with normal developmental milestones. There were bilaterally symmetrical dry, erythematous scaly plaques over both the nipples, areolae, and periareolar area. She had a similar but milder eruption on both cheeks as well as on the trunk [Figure 1] and [Figure 2]. A diagnosis of atopic dermatitis was made. The patient was prescribed fluticasone ointment followed by petroleum jelly twice daily on the affected areas leading to the resolution of lesions in 10 days [Figure 3]. She continues to be well except for complaint of dry nipples a month ago which responded to petroleum jelly application three times a day and reduction of soap application to twice weekly.
Figure 1: Bilateral nipple eczema with an erythematous rash on the face and abdomen

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Figure 2: Close-up of eczematous nipple and areola

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Figure 3: Complete resolution of nipple and areolar eczema after treatment for 10 days

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Nipple eczema denotes localized dermatitis of the nipple as well as areola and is often bilateral.[1] Essentially a clinical diagnosis, it is characterized by erythematous papules, crusting, oozing, erosions, and rarely nipple discharge, if infected.[2] Bilateral nipple eczema in this child presenting with pruritic eczematous lesions over the cheeks and trunk and a strong family history of atopy is an obvious minor criterion for the diagnosis of atopic dermatitis.[1] However, it is a rare finding in Indian studies. In a recent study from South India aimed at establishing the frequency of Hanifin and Rajka's minor criteria, none of the 174 children was found to have nipple eczema.[3] Studies from North India too corroborate its rarity.[4],[5] Even in world literature, the prevalence of nipple dermatitis as a manifestation of atopic dermatitis is higher in the adolescent age group and rare in infancy.[6],[7],[8] We present this 7-month-old infant with bilateral nipple and areolar eczema as the predominant manifestation of atopic dermatitis for its rarity in this age group.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kaur A, Kumar R, Gupta S. Nipple eczema in an adolescent girl presenting with persistent unilateral nipple discharge. BMJ Case Rep 2020;13:E237691.  Back to cited text no. 1
    
2.
Barankin B, Gross MS. Nipple and areolar eczema in the breastfeeding woman. J Cutan Med Surg 2004;8:126-30.  Back to cited text no. 2
    
3.
Parthasarathy N, Palit A, Inamadar AC, Adya KA. A study to estimate the frequency of Hanifin and Rajka's minor criteria in children for diagnosis of atopic dermatitis in a tertiary care center in South India. Indian J Paediatr Dermatol 2020;21:31-5.  Back to cited text no. 3
  [Full text]  
4.
Kanwar AJ, Dhar S, Kaur S. Evaluation of minor clinical features of atopic dermatitis. Pediatr Dermatol 1991;8:114-6.  Back to cited text no. 4
    
5.
Nagaraja, Kanwar AJ, Dhar S, Singh S. Frequency and significance of minor clinical features in various age-related subgroups of atopic dermatitis in children. Pediatr Dermatol 1996;13:10-3.  Back to cited text no. 5
    
6.
Julián-Gónzalez RE, Orozco-Covarrubias L, Durán-McKinster C, Palacios-Lopez C, Ruiz-Maldonado R, Sáez-de-Ocariz M. Less common clinical manifestations of atopic dermatitis: Prevalence by age. Pediatr Dermatol 2012;29:580-3.  Back to cited text no. 6
    
7.
Shi M, Zhang H, Chen X, Zong W, Tang J, Han X, et al. Clinical features of atopic dermatitis in a hospital-based setting in China. J Eur Acad Dermatol Venereol 2011;25:1206-12.  Back to cited text no. 7
    
8.
Beltrani VS. The clinical spectrum of atopic dermatitis. J Allergy Clin Immunol 1999;104:87-98.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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