Nipple Thrush Risk Increases With Nipple-Areolar Complex Conditions

Patients who are lactating with nipple-areolar complex (NAC) conditions are more likely to have nipple thrush than nipple dermatitis and the occurrence of thrush is related with use of breast pumps, according to a research letter published in Journal of the American Academy of Dermatology.

Researchers retrospectively reviewed NAC cases documented between 2015 and 2019 at a tertiary health system.

Patients who were lactating (N=204) with NAC conditions reported nipple pain (n=155), breast pain (n=83), general NAC irritation (n=80), nipple and breast pain (n=70), nipple and breast pain with NAC irritation (n=33), itch (n=23), and burn (n=17).

Women who reported breast feeding exclusively by nursing reported no incidence of itch or burn.

Overall, nipple dermatitis was rare (7%) and women with symptoms of itch or burn were more likely to have thrush (58%) than dermatitis (23%). More than one-half of the women with breast and nipple pain with NAC irritation were diagnosed with thrush (52%).

Nipple thrush was more common among women who exclusively pumped (odds ratio [OR], 23.4; 95% CI, 2.5-218.7; P =.0006) or both pumped and nursed (OR, 11.8; 95% CI, 1.3-110.1; P =.03) compared with women who exclusively nursed.

Researchers noted that dermatologists were rarely involved in the management of NAC conditions (2%). This likely indicates there is an unmet need for dermatology-involved multidisciplinary care in NAC nipple pain.

Limitations of the study include the retrospective, single-institution study design and the fact that thrush was almost exclusively diagnosed without microscoping confirmation (98%).

Letter authors conclude, “The risk of NAC dermatitis is increased postpartum as patients are using new bras and detergents, applying novel and often pro-allergenic substances directly onto their NAC, and mechanically irritating the NAC skin with breast pumps.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

This article originally appeared on Dermatology Advisor