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Inflammation of the nipples
There are some places on the body where a local inflammation is particularly troublesome. The nipple inflammation is undoubtedly one of them here. The female sex in particular sometimes suffers very much from the accompanying complaints, as the breast anatomy in women is particularly complex and can therefore produce a more intense complaint. Fortunately, there are numerous treatment options in the field of alternative medical and medicinal plant therapy that offer reliable help in the event of inflammation of the nipples. You can find useful tips on treatment and important details about the disease in the following article.
The nipple (Mamilla) describes in the area of the chest (Mammae) part of the secondary sexual characteristics that men and women have in common. However, the nipple usually only has a functional role in the female sex. As is well known, this is to provide the baby with breast milk during breastfeeding. For this purpose, the mammary glands located inside the breast (Glandula mammaria) breast milk after pregnancy. Said glands are anatomically located in front of the pectoral muscle and are encased in a more or less pronounced fatty tissue that is only significantly reduced in the area of the nipples. At this point the milk ducts (Ductus lactiferi) from the mammary glands, which channel the breast milk produced and thus allow it to exit the nipples.
The nipple inflammation now describes an inflammation at this sensitive mouth of the mammary glands or the milk ducts. Basically, both men and women can experience this kind of inflammation, although the risk in women is significantly higher due to the full functionality of the breast system. To make matters worse, there is a much more sensitive network of nerve tracts and lymphs around the female nipples than in men. Irritation from outside as well as the body's own imbalances in the metabolism or hormonal balance of the woman are therefore perceived much more easily by the female mamillae and consequently also lead to inflammatory irritation reactions more quickly. Typical accompanying symptoms of such an inflammation are redness, swelling and pain in the nipple.
In this context, inflamed nipples are relatively often due to an already existing inflammation inside the breast. However, there are numerous other conceivable reasons for the inflammatory process. The causes of occurrence can be roughly divided as follows:
- Breast diseases,
- Chest injuries,
- hormonal disorders
- and allergic reactions.
Inflammation of the mammary gland as the main cause
Inflammation of the mammary gland (mastitis) is by far the most common cause of nipple inflammation. This is a pre-inflammation that later spreads to the nipple. Even the development of mastitis shows how versatile inflammation of the nipples can be when an infection in the area of the breast is involved. Because mastitis (also: mastadenitis) is primarily caused by an existing bacterial infection. Typical infectious agents are:
- Escherichia (Escherichia),
- Mycobacteria (Mycobacterium),
- Proteus bacteria (Proteobacteria),
- Pseudomonies (Pseudomonas),
- Staphylococci (Staphylococcus)
- or streptococci (Streptococcus).
Staphylococci can be identified as the causative agent in approximately 90 percent of all mastitis cases. To be more precise, it is mostly the pathogen Staphylococcus aureusthat triggers inflammation of the breast. This is especially true for puerperal mastitis, a special form of mammary gland inflammation that only occurs during breastfeeding and is caused by wound infections in the chest area. At the same time, milk build-up (for example due to narrow milk ducts) is considered by medical professionals as an additional co-factor.
Of course, mastitis can also occur outside of breastfeeding. This is called mastitis non-puerperalis. In addition to staphylococci, the most common causes of mammary gland inflammation and nipple inflammation as a secondary disease are other pathogens that are notorious as the cause of serious infectious diseases. Two examples of this are the tuberculosis pathogen Mycobacterium tuberculosis and the stick bacterium Escherichia coli. The latter occurs naturally in the human intestine like other intestinal bacteria, but can also be responsible for serious infectious diseases such as meningitis, urinary tract infections and even chronic inflammatory bowel diseases such as Crohn's disease and ulcerative colitis if it is overpopulated or carried over to other parts of the body. Co-factors in non-puerperal mastitis are also weaknesses and disorders in the immune system, hormonal balance and breast tissue due to:
- Taking psychotropic drugs (e.g. tranquilizers),
- Taking hormone preparations (e.g. pill),
- an increased level of prolactin in the blood (hyperprolactinemia),
- a disturbed estrogen or progesterone balance (for example in the case of mastophilia),
- heavy nicotine consumption
- or thyroid disorders (for example, hyperthyroidism).
A third variant of mastitis and thus another conceivable reason for nipple inflammation is periductal mastitis. It is the only form of mammary inflammation in which infectious agents play less of a role. Rather, this mastitis is triggered by a milk jam in nursing mothers. As a result, the milk secretion can no longer or only inadequately drain off through the nipples and is therefore looking for alternative ways of entering the surrounding breast tissue. Of course, this leads to tissue irritation, which inevitably triggers extensive inflammatory reactions, laying the foundation for both mammary gland and nipple inflammation.
Injuries and infections as a co-factor
Inflammation of the mammary glands and nipples caused by bacterial infections usually occurs whenever the responsible pathogens penetrate the nipple tissue via micro-injuries. This can happen during breastfeeding, for example, if the baby sucks too much on the mother's nipples. But other injuries in the nipple area also favor bacterial infection of the breast. If the surgical wound becomes infected during a breast operation, for example, inflammation of the nipple cannot be ruled out. The infection background is in most cases a lack of sterility in the wound. The situation is similar for cuts and abrasions on the nipple. Although these are relatively rarely involved in the development of nipple inflammation, they are in principle conceivable as a possible cause.
Injuries to the nipple therefore offer possible infection germs direct access to the breast tissue with corresponding tissue irritation and inflammatory processes as a result. In addition, there are existing infectious diseases, which, if not properly cured, can lead to subsequent infections if the pathogens settle in the breast via the bloodstream or lymph flow. The inflammation of the mammary gland in particular begins all too easily via such a path. A distinction is made between three main forms of mastitis, depending on how they develop.
Nipple inflammation due to tissue abnormalities
Infections are often associated with pus formation in the affected tissue. Breast infections are of course not excluded from this scenario. Therefore, inflammation of the nipples can also occur in the course of pus cysts or abscesses.
Even pimples and edema, i.e. water retention in the chest, for example due to dropsy, are by no means as absurd as the cause, as it may initially appear. An inflammatory reaction is all the more likely if patients squeeze a lot of the tissue anomalies and thus provoke a migration of the fluid or secretion accumulations into the surrounding tissue.
However, breast cancer is the most dangerous form of tissue growth with regard to breast inflammation. Any malignancy, carcinoma or even a large tumor can cause nodular hardening in the area of the nipple, which in addition to nipple inflammation also causes itching, discharge and crusting of the breasts. In this regard, inflammation is very common if the lymphatic system is involved.
Inflammation of the nipples due to breast malformation
Although mastitis is by far the most common cause of nipple inflammation, it is not the only one. Among other things, it is possible that abnormal breast development can cause the inflamed nipples. For example, some women suffer from breast malformations, which, in addition to changes in the shape of the breast, also promote constricted or insufficiently developed mammary glands. For example, if there is an excessively large breast, better known as a large breast (macromastia), patients sometimes not only suffer from severe physical complaints such as back pain or poor posture due to the additional weight. Likewise, greatly enlarged mammary glands are conceivable, which places an enormous burden on the breast tissue and, if necessary, can also favor inflammatory processes due to irritation.
The counterpart to the macromastia is the underdevelopment of the breast or small breasts (micromastia). There is a risk of simultaneous underdevelopment of the mammary glands, which are consequently too small or not completely developed at all. Especially in special hormone phases of the female body (for example, during the cycle or pregnancy), when the mammary glands are stimulated more by a changed hormone level, inflammation can also occur due to irritation.
Between the macromastia and the micromastia there are some other shape deviations of the female breast, which are accompanied by more or less severe complications. A tube or funnel breast, for example, can cause problems with breastfeeding and massively impair a woman's self-esteem if she judges herself too strongly according to the valid, but also extremely variable beauty ideals of our society. It should be emphasized at this point that in terms of breast shape and breast size, not every deviation from the norm also automatically leads to an increased risk of inflammation. Especially when it comes to the shape of the breast, most deviations are harmless. The shape of the nipple itself can be significantly more complicated. In particular, the nipple (also: hollow nipple) harbors not only problems with breastfeeding but also the risk of causing nipple infections. They are due to shortened milk ducts and can, for example with a changed hormone status, be more prone to inflammation.
Hormonal changes and nipple inflammation
As is well known, hormonal disorders can cause numerous diseases. Nipple inflammation is a possible scenario here. Especially with existing cycle disorders due to an unbalanced progesterone or estrogen balance, many women complain about painful and inflamed nipples. And even during pregnancy and menopause, the female body is subject to special hormone fluctuations, which result in tissue remodeling in the breast and can sometimes promote nipple inflammation through tissue irritation.
In men, hormone changes in old age are not uncommon for nipple infections. An increase in the female hormone estrogen plays an important role here, which leads to extensive remodeling processes in the male breast and can thus initiate inflammatory processes. The same applies to a drop in estrogen levels in menopausal women. Here, too, the breast tissue changes permanently, which can lead to temporary inflammation until the end of the remodeling phase.
Allergies and nipple inflammation
An intolerance to certain allergens can also show up in nipple inflammation. This is the case, for example, if there is a textile allergy and the mamilla is irritated permanently by the textile when wearing appropriate clothing. The allergic reaction can of course also be caused by detergents used in textiles. In this regard, painful and inflamed nipples can also develop in men. When it comes to textiles, irritation from poorly fitting bras or bras made from unsuitable textile fabrics is mostly responsible for the inflammation in women.
Inflammation of the nipple can occur on one or both sides and shows the classic signs of inflammation. It usually begins with a slight sensitivity to pressure and friction in the area of the nipple. Manipulations on the nipple, whether when breastfeeding the child or through rubbing clothes, are suddenly felt to be painful. This discomfort can quickly develop into very severe pain that affects the entire chest and radiates down to the armpit. Often there are complaints even with isolated movements of the arm.
In addition to the pain, local redness may appear. However, since the nipple is usually darker in color, this symptom is often not recognized or is recognized only late. Only when you take a closer look or if the nipple is swollen and overheated, do people become aware that the nipple looks different than usual. The redness, overheating and swelling of the nipple can also spread and ultimately spread to the entire breast tissue. In this case, the blood vessels shimmering through the skin are significantly exaggerated and the entire breast or larger parts can be very red, hot and swollen. Now local rashes across the entire chest up to the neck are not uncommon. Frequently, bloody-purulent secretions then emerge from the nipple or crusting on the surface of the nipple can be seen. If there is inflammation of the nipple during breastfeeding, breast milk may also have a different color and contain blood.
In general, every nipple infection carries the risk of an inflammation of the mammary gland, that is, the local inflammation spreads to the mammary gland. It is also possible for the pathogens to enter the blood, which is then called sepsis. Both clinical pictures are serious complications of nipple inflammation and, in addition to the symptoms limited to the affected breast, are also noticeable by other, non-specific signs of the disease. These include:
- Fatigue and general feeling of sickness,
- Swollen lymph nodes in the armpit and neck area
- or fever and chills.
The treating doctor usually diagnoses nipple inflammation with the typical symptoms and a physical examination, which must include the palpation of both breasts. Since there are many causes behind nipple inflammation, this is often followed by further examinations.
Laboratory chemical tests
Inflammation levels can be determined in the blood of those affected. If there is inflammation of the nipple or other parts of the breast far from pregnancy and lactation, it is advisable to determine the level of prolactin in the blood. This is then often increased and can indicate a hormonal cause. If secretion flows out of the nipple, it can be checked for pathogens using a microbiological smear.
The breast can be assessed very well using a sonographic examination. Abscesses or other masses can be identified in this way. Since an inflammation in the area of the breast must always be considered cancer, in case of doubt a mammography, as well as a CT and MRI examination can also be considered.
Therapy for nipple inflammation depends entirely on the underlying cause. In many cases, it is sufficient to counter the inflammation with home remedies or medicinal herbs until the body's immune system has taken care of the inflammatory pathogens or external stimuli (in this case mainly breastfeeding the baby) come to an end. Overall, the options outlined below are available for treating inflammation.
Simple nipple infections and also inflammation of the mammary glands respond very well to various home remedies in the early stages. Those affected should experience for themselves and judge accordingly whether local cooling therapy or rather heat therapy provides relief. Cooling elements can be used for cooling, which are placed on the affected area within a maximum of ten minutes at a time. However, the breast should be protected from the direct cooling effect with a cloth. Even moist envelopes, for example with peppermint as an additive, can counteract the inflammation.
Cabbage wrap is a tried and tested remedy, especially among breastfeeding women. To do this, take a cleaned cabbage leaf from the refrigerator and place it on the affected breast. The pre-cooled cabbage not only has a cooling effect, it also contains plant substances that can inhibit local inflammation.
If patients suffering from inflammation tend to undergo heat treatment, moist and warm envelopes, for example with chamomile additives, can also improve the condition, but brief exposure to an infrared lamp for a maximum of ten minutes. Milking fat is also used time and again to soothe red and irritated nipples during pregnancy.
A good and, above all, anti-inflammatory breastfeeding culture is very important for breastfeeding mothers. For this it is advisable to heed the following advice:
- Ensure a relaxed atmosphere at the start of breastfeeding,
- only breastfeed with well-practiced breastfeeding in less relaxed situations,
- try to reduce mental pressure (for example, "I need to breastfeed")
- wear a supportive but not restrictive bra (initially also at night),
- spread both breasts towards the nipple in the warm shower,
- when the sensitivity to pain begins, do not extend the breastfeeding unnecessarily,
- Apply anti-inflammatory ointments (e.g. with zinc or chamomile) during breastfeeding breaks
- and breastfeeding aids (e.g. nursing hats) as instructed by the midwife.
Even in the area of naturopathy, you will quickly find what you are looking for if there is slight inflammation of the nipple or breast. For external use on the nipple, envelopes with tinctures can be made from:
- Black tea
- or black cohosh
inhibit the inflammatory reactions and provide cooling. For internal use, for example as globules, tablets or tinctures, the following are suitable:
- Hepar sulph
- or Magnesium phosphoricum (Schüßler Salt No. 7)
to curb the inflammatory response, relieve pain and stimulate a dry milk flow.
The drug treatment of nipple inflammation or mammary gland inflammation depends very much on the cause of the inflammation. Sometimes they can also occur as a side effect of hormone or psychopharmaceutical treatment. Then it is advisable to consult with the doctor to what extent the initiated treatment makes sense in terms of alleviating the symptoms to be treated and the side effects. A reduction or discontinuation of the medication should definitely be discussed.
The means of choice for nipple and general breast inflammation is usually an adapted antibiotic therapy. Breastfeeding mothers - the main risk group for this clinical picture - are often very afraid of this. However, these women don't have to be afraid. The antibiotic active ingredients do not endanger the breastfeeding child. Weaning should also only be considered in very few exceptional cases, since this procedure often adds to the inflammation and symptoms. In the vast majority of cases, only complications in the child with antibiotic therapy for the nursing mother can be expected to be infected with oral thrush.
To alleviate the general symptoms of the disease, it is advisable to use antipyretic and analgesic drugs. These drugs usually also have an anti-inflammatory component and help the body fight inflammation. Since breastfeeding women are not allowed to take all of these so-called non-steroidal anti-inflammatory drugs, this group of patients should definitely seek medical advice in advance.
Operative care is only necessary in very rare cases. However, if an abscess has formed in the mammary gland in the course of an inflammation of the nipple, it may be necessary under certain circumstances that it is surgically removed and the wound cavity is treated with surgery. For example, if the inflammation does not respond to antibiotic therapy or if the inflammation is very advanced.
Even if the inflammation is caused by cancer or a special malformation of the mammary glands or milk ducts, it is necessary for a surgeon to treat the affected breast. In the case of nipples, many patients also resort to the installation of a nipple piercing. This can permanently pull the warts outwards and thus eliminate the risk of inflammation.
Diseases and malformations in nipple inflammation:
- Breast cancer,
- hormonal disorders,
Author and source information
This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Miriam Adam, Dr. med. Andreas Schilling
- Anja Jacobs et al .: S3 guideline: Therapy of inflammatory breast diseases during breastfeeding, guideline of the German Society for Gynecology and Obstetrics (DGGG), (accessed July 10, 2019), AWMF
- Julie S. Moldenhauer: Mastitis, MSD Manual, (accessed July 10, 2019), MSD
- J. Peters: Mastitis puerperalis - causes and therapy, Zentralblatt für Gynecologie, (accessed July 10, 2019), PubMed
- Volker R. Jacobs, Kirstin Golombeck, Walter Jonat, Marion Kiechle: Mastitis Nonpuerperalis after Nipple Piercing: Time to Act, International journal of fertility and women's medicine, (accessed July 11, 2019), PubMed
ICD codes for this disease: N61ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.