Why Are My Nipples Itchy? Common Causes and Solutions

From minor irritations to underlying health concerns, the sensation of itchy nipples can range from bothersome to distressing. Whether the itching is linked directly to a problem or the cause is unknown, it’s an uncomfortable and potentially hindering symptom. Let’s dive into the origins and possible causes of itchy nipples, as well as some potential relief.

Common causes of itchy nipples

Itching of the nipples is typically a symptom of another issue or underlying condition. Let's review the potential causes of nipple itchiness and how to best treat and prevent them from occurring.

Dry skin, also known as xeroderma

The skin barrier requires hydration to maintain a healthy wall from the external environment. The skin barrier is seen as a 'brick wall' and the 'mortar' is made of fat cells or lipids. When the lipids are not well moisturized, they can shrink and result in cracks in the 'mortar,' allowing water to flow out of the skin in a process called transepithelial water loss.

Pregnancy and breastfeeding

Fluctuations in the hormone levels during pregnancy, as well as the increase in breast size, can result in stretching of the skin, leading to itching. A hormone called prolactin stimulates mammary tissue growth and prepares them for breastfeeding, resulting in swelling of the breast tissue. The expansion of breast tissue can often cause itching along the breast and nipple.

Dermatitis

Otherwise known as eczema, dermatitis is a chronic condition that results in inflammation and redness of the skin. Itching can break the skin and result in the skin 'weeping' fluid. It is not contagious and can flare up due to stress, inflection, or environmental triggers. These are the most common types of dermatitis and each has its own symptoms as follows:

• Atopic dermatitis. Commonly found in children, but also relevant to people of all ages, it is characterized by dryness and itchy skin.
• Contact dermatitis. Often called 'allergic contact dermatitis,' it is caused by environmental triggers such as soaps, perfumes, and certain fabrics that have direct contact with the nipple.

Hormonal changes

During the development of breasts and before menstruation, hormone levels, including estrogen and progesterone, change, resulting in breast swelling or growth. This swelling can be coupled with inflammation of the breast tissue and result in itchy skin.

Yeast infections

Known as 'thrush,' yeast infections primarily occur in the presence of breastfeeding. Damage to the nipple and recent antibiotic use can also increase the risk for nipple thrush development.

Research studies of nipple thrush are limited and often scrutinized in the scientific community; however, it remains a common diagnosis. The yeast that most often causes thrush is called Candida albicans and is found on the skin under normal conditions.

When there is overgrowth of yeast, thrush can develop. Antibiotics can reduce the amount of normal 'flora' (bacteria and fungi) in your body and leave you susceptible to other organisms growing. This 'flora' in your body provides defenses to the body from external threats. When that flora is damaged or if antibiotics eliminate the flora, there isn't a defense system in place, and it can lead to infection.

Psoriasis

Psoriasis typically occurs on the scalp, elbows, and knees; while rare, it is possible that the nipples are affected. Psoriasis is a chronic condition caused by an overactive immune system, which results in an overproduction of skin cells. These rapidly growing cells can then form lesions on the surface of the skin. The patches can pull at normal skin, resulting in irritation and itching.

Jogger's nipple

Jogger’s nipple is caused by chafing of clothing or sports bras against the nipples, typically while running or being physically active. When an ill-fitting bra or tight clothing rubs up against the skin, it can cause irritation and skin breakdown leading to sore, itchy nipples. Cotton material, damp clothing, and logos can all contribute to the development of jogger's nipple.

Paget’s disease of the breast

Paget’s disease is a rare form of breast cancer that targets the areola and nipple of one side of the breast. With Paget's disease of the breast, there is often a tumor found behind the nipple, which may sometimes be felt. Symptoms include crusty, scaly, and red tissue around and on the nipple and possible yellow discharge. The buildup of malignant (cancerous) cells from Paget's disease can result in the development of plaques on the surface of the nipple and breast. These plaques are a source of inflammation and irritation and can cause burning and itching in the area.

Inadequate hygiene

Poor hygiene can result in direct bacteria accrual on the breast. Skin cells are shed continuously throughout the body, and when bathing is not consistent, layers of dead skin cells can build up. This layer of dead skin cells can also attract bacteria and fungi to stick to it, leading to a potential infection.

Mastitis

Mastitis is an inflammation within the breast, typically caused by an infection. Most commonly, it is a result of a clogged duct while breastfeeding. When a duct is not properly emptied and milk proteins build up, the duct can become clogged and lead to engorgement (swelling) of the breast. When the tissue expands and inflammation is triggered, tissue can become sore and irritated as a response.

Symptoms of itchy nipples

Symptoms of itchy nipples typically include:

• Flaky, dry skin
• Pruritus (itching) of nipples and surrounding area
• Rash along nipple
• Tingling
• If thrush is present, the nipples may be stinging and itching

Treatment for itchy nipples

With each unique cause for itchy nipples, there is a unique treatment. If taking any medication or adding a new product to your routine, please consult a healthcare provider beforehand.

• Dry skin. Use gentle cleansers, stay hydrated throughout the day, and apply moisturizing creams (emollients) regularly.
• Breastfeeding. Continue regular breastfeeding in an attempt to relieve engorgement, ensure proper latch, and alternate breast sides. In some cases of mastitis, your doctor may prescribe a course of antibiotics. Frequent emptying of the infected breast is recommended. If a yeast infection is suspected during breastfeeding, check your baby for signs of thrush (white patches in their mouth). To treat this form of thrush, oral medicated drops may be prescribed for the infant, and antifungal medications may be prescribed to the mother. Ensuring proper hygiene and keeping your nipples dry will also aid in the treatment of nipple thrush.
  
• Dermatitis. Emollients are recommended in cases of both atopic and contact dermatitis. The type and cause of dermatitis may require a visit to your primary care physician, who may prescribe corticosteroids and offer further treatment options. Avoiding triggering causes is crucial in cases of contact dermatitis.
• Hormonal changes. Symptom management with cool/warm moist compresses. If PMS is triggering the itching, there is some evidence that lifestyle modifications such as reducing caffeine intake and increasing intake of vitamin E- and B6-rich foods could help alleviate the cyclical breast discomfort that may potentially be accompanied by itchiness.
• Psoriasis. Topical steroids, phototherapy (UV light treatments), and medications or injections for more severe cases.
• Jogger's nipple. Wear loose-fitted clothing and a well-fitted sports bra (or no bra) to prevent friction and chafing.
• Paget’s disease of the breast. Treatment of Paget’s disease is treatment of breast cancer and typically involves surgical removal of the tumor or whole breast and chemotherapy, radiation therapy, or hormone therapy may be necessary.
• Inadequate hygiene. Use mild, unscented soap to gently wash the area daily.

Everyday care tips for itchy nipples

There are a few at-home remedies that can help alleviate the symptoms of itchy nipples and should be used with care. If symptoms persist, worsen, or you notice any nipple or areola skin changes or feel a lump in your breast, visit your primary healthcare provider.

• Cool compresses. They can help relieve inflammation. Place a cool towel or ice pack on the afflicted area for 20 minutes at a time. Be sure not to place the ice pack directly on the skin — wrap it in a towel or shirt first.
• Good hygiene. Use mild, unscented soaps and no harsh scrubbing. Only use water on open skin. Aim for daily bathing or showering to ensure clean, supple skin and a protected skin barrier.
• Avoid scratching. Scratching can lead to a break in the skin and to a potential infection. Lightly rub or pat the area to relieve the itching.
• Clothing. Wear loose-fitting, soft clothing. Opt for garments made of materials that are less likely to irritate the skin, such as cotton.
• Aloe vera. Studies have found it helps reduce inflammation and promotes healing. You can place it in the fridge before using it for cold relief.
• Petroleum jelly. Provides a barrier over the nipple when applied. Aids in retaining moisture and prevents harmful organisms from direct contact.
• Unscented lotion. Many perfumes are added to lotion — these scents can cause irritation to the skin and further the discomfort.
• OTC anti-itch cream. Utilize ointments and creams with hydrocortisone. It is a steroid that calms the inflammation and reduces the pain associated with itching and irritation.

Diagnosis

If the symptoms are persistent or you notice any changes in your nipple or areola (the area surrounding the nipple) skin, a visit to your provider is recommended. They will perform a thorough physical exam of the breast area as well as collect a medical history from you. Questions regarding activities, skin products, family history of cancers and other diseases, and even frequency of showering may be asked to identify potential triggers. The doctor may order an ultrasound, a mammogram, or a biopsy (a small piece of tissue from the breast removed and tested) if indicated.

When to seek professional help

Seeking the help of a medical provider is recommended when the following symptoms are present:

• Pain and burning sensation in the nipple area
• Scaly, flaky nipple or areola rash
• Crusty hardened skin patches on the nipple or around it that resemble eczema
• A lump in your breast
• Dimpling or puckering of the skin around the breast, orange-peel-looking skin
• Abnormal discharge (i.e., green, yellow, foul smelling, bloody, white)
• Nipple changes (pulling inward or changing direction)

There are numerous causes of itchy nipples, and they are often a symptom of an underlying condition. Careful monitoring and management of the skin on and around the nipples can support a healthy breast and prevent discomfort caused by itching. If symptoms of itchy nipples are persistent, cause discomfort, or are accompanied by any skin changes and you feel a lump in your breast, a call to your medical provider is always indicated to ensure proper diagnosis and effective treatment.