Treatment of hyperkeratosis areolae mammae naeviformis with the carbon dioxide laser

[Therapeutic escalation in a case of nevoid hyperkeratosis of the areola and the nipple]

Nevoid hyperkeratosis of the nipple areola complex (NAC) is a rare dermatological pathology of unknown etiology, first described in 1923. It is a benign condition characterized by verrucous thickening and brownish discoloration of the NAC. We described the case of a 26-year-old woman with bilateral nevoid hyperkeratosis of the NAC. Several lines of treatment have been used with varying efficacy: conservative (calcipotriol and local retinoids), semi-conservative (CO2 laser) and surgical (excision and total skin graft). The final result is very satisfactory and without recurrence at 1 year follow-up.

Skin diseases of the breast and nipple: Inflammatory and infectious diseases

Certain dermatologic conditions are unique to the breast and nipple, whereas others may incidentally involve these structures. All require a nuanced approach to diagnosis and treatment because of the functional, sexual, and aesthetic importance of this area. The lactating patient requires special management because certain treatment options are contraindicated. All dermatologic conditions involving the breast and nipple require careful evaluation because malignancy of the breast can be mistaken for a benign condition or may trigger the development of certain dermatologic conditions. The second article in this continuing medical education series reviews common and uncommon inflammatory and infectious conditions of the breast and nipple and provides insight into both the diagnosis and the treatment of this heterogeneous group of diseases. For the purposes of this article, these conditions are divided into 4 distinct categories: 1) dermatitis; 2) radiation-induced changes; 3) mastitis; and 4) miscellaneous dermatologic conditions of the breast and nipple.

Radical treatment of extensive nevoid hyperkeratosis of the areola and breast with surgical excision after mild response to topical agents: A case report

INTRODUCTION

Nevoid hyperkeratosis of the nipple and/or areola (NHNA) is a benign lesion with a female predominance and an aesthetically disturbing appearance. Spontaneous remission is not reported and medical treatments proposed so far have shown variable results.

PRESENTATION OF CASE

We describe a rare case of an extensive variant of NHNA covering almost the entire breasts' surface. At present, only three other reports are present in the literature. Medical treatment proved not completely effective and the patient was also affected by a significant breast asymmetry-hypertrophy. Therefore, NHNA was managed surgically with excision of the areolar affected portions while performing breast reduction-lift. The result was satisfactory and without recurrence of lesions at 5-year follow-up.

DISCUSSION

This case reported favorable outcomes of surgery for NHNA. Reports of success with these procedures are still limited, but the promising results in terms of radicality and aesthetic outcome suggest it should be offered to patients as a viable therapeutic option.

CONCLUSION

Indications for surgical treatment of NHNA can be: unsatisfying response to topical agents; young patients who want to restore the aesthetic appearance of the breast; and patients with concomitant indication for corrective surgery of the breast. Advantages are: predictable time of healing; predictable final result; radical excision of the affected tissue; and possibility of histologic analysis of the whole areola. In rare cases of lesions extending to the breast, preliminary treatment with topical agents can limit the extent of excision. Management and treatment should always be tailor-made for each individual case.

Naevoid hyperkeratosis of the nipple and areola: an extensive form in two adolescent Filipino females

Few cases of naevoid hyperkeratosis of the nipple and areola (NHNA) have been documented since the condition was first described in 1923. A recent PubMed search (Mar 2014) yielded 107 cases of NHNA in the world literature, mostly female patients with adolescent-onset disease. We report the first two cases of adolescent-onset NHNA from the Philippines. To our knowledge, these are also the first two cases of extensive bilateral NHNA reported in which the lesions have extended beyond the areolae affecting the surrounding periareolar skin, covering almost the entire breast. Medical treatment of NHNA has been commonly associated with treatment failure or recurrence after treatment cessation, requiring intermittent therapy. However, our two cases had successful outcomes with medical treatment using a combination topical steroid/salicylic acid ointment with > 2 years of follow-up.

Surgical approach for nevoid hyperkeratosis of the areola

Nevoid hyperkeratosis of the breast is a rare condition affecting the nipple, the areola or both. It appears in both sexes and it can by lateral or unilateral. It can also accompany other skin diseases or systemic conditions including malignancies. Treatment may not be easy due to aesthetic consequences but surgery seems to be the most preferable therapeutic option. We report such a case successfully managed by surgical intervention.

Nevoid hyperkeratosis of the areola misinterpreted as mycosis fungoides

Nevoid hyperkeratosis of the nipple and areola is a benign condition with fewer than 70 cases reported in the literature. We report a case of unilateral nevoid hyperkeratosis of the areola with intraepidermal lymphocytes that resembled Pautrier's microabscesses on histological examination. This is the third report of mycosis fungoides-like changes in nevoid hyperkeratosis of the nipple and areola. In addition, this is the first case to present immunohistochemical and T-cell gene rearrangement studies of the intraepidermal lymphocytes. This case highlights a potential histopathological pitfall in the diagnosis of nevoid hyperkeratosis of the nipple and areola.

Treatment of Nevoid Hyperkeratosis of the Nipple and Areola Using a Radiofrequency Surgical Unit

BACKGROUND

Nevoid hyperkeratosis of the nipple and areola (NHNA) is a rare condition of unknown etiology. Verrucous thickening and pigmentation of the nipple and areola are the main features of the condition. Different therapeutic options, both medical and surgical, have been described.

OBJECTIVE

To use a radiofrequency surgical unit to treat an NHNA case, which was unresponsive to keratolytic therapy.

MATERIALS AND METHODS

The lesions of the nipple and areolas were excised tangentially with a diamond-shaped electrode of a radiofrequency surgical unit under local anesthesia.

RESULTS

The patient had a good cosmetic appearance after the treatment, and there was no recurrence at the ninth postoperative month.

CONCLUSION

Radiofrequency for tangential excision in the treatment of NHNA lesions that have not responded to medical therapy can be an alternative surgical method.

Surgical treatment of nevoid hyperkeratosis of the areola by removal of the areola and reconstruction with a skin graft

Hyperkeratosis of the nipple and areola is a rare, sporadic, benign condition characterized by verrucosus thickening and brownish discoloration of the nipple and areola. Approximately 50 cases of hyperkeratosis of the nipple and areola have been reported in the literature. Dermatologists treated most of them conservatively. We have described the case of healthy 19-year-old girl with bilateral nevoid hyperkeratosis of the areola and our treatment by surgical removal of the areola and reconstruction with a skin graft. As far as we know, this is the first report of this kind of treatment. The final result is esthetically excellent and without recurrence during 12 months' follow-up.

Nevoid hyperkeratosis of the nipple and areola: a distinct entity

Although nevoid hyperkeratosis of the nipple and areola was initially described in 1923, there are only case reports or reviews about it; no large series have been documented to date. The clinical features of the reported cases in the literature are not uniform, and it is questioned whether nevoid hyperkeratosis of the nipple and areola is a distinct clinicopathologic entity or a clinical presentation of various dermatoses. We describe 7 cases with hyperkeratotic nevoid lesions localized on the nipple and areola with different clinical features. None of them had any other associated dermatologic or systemic disease. Histopathologic examination was performed in 6 patients. Four of them had common histopathologic features suggesting a distinct entity, namely, nevoid hyperkeratosis of the nipple and areola; 2 of them had histopathologic features consistent with seborrheic keratosis. Seborrheic keratosis presents as sharply demarcated papules or plaques, whereas nevoid hyperkeratosis of the nipple or areola presents as a plaque diffusely involving the nipple or the areola.

Nevoid hyperkeratosis of the nipple and areola: treatment of two patients with topical calcipotriol

Nevoid hyperkeratosis of the nipple and areola, which is characterized by verrucous thickening and pigmentation of the nipple or areola, is a rare condition. Different therapeutic options have been used with varying results, but there is no uniformly effective treatment. We describe two patients with hyperkeratosis of the nipple and areola who responded well to topical calcipotriol ointment.