Nevoid Hyperkeratosis of the Nipple and/or Areola: Treatment with Topical Steroid
A 20-year-old female was referred to the dermatology outpatient clinic of Razi hospital, Tehran, Iran in August 2010. She suffered from a 2-year history of asymptomatic discoloration and thickening of the both areolas []. It initiated with a pink, scaly, and eczematous plaque of areola, which gradually became darker. Worsening during the past 2 months, disturbed and encouraged her to seek medical care. There was no history of atopy, bloody discharge, breast malignancy, or drug intake.\nOn examination, there was a diffuse brownish pigmentation and verrucous thickening of the whole right and upper part of the left areola with overlying scale-crust. No abnormal findings including palpable mass, lymphadenopathies, nipple retraction, or discharge were encountered.\nOther dermatologic examination was unremarkable. She was not obese at all. Routine laboratory tests were within normal limits.\nA skin biopsy specimen showed marked thickening of the epidermis with slight papillomatosis and downward filiform rete ridges, anastomizing to each other. The basal layer of the epidermis was hyper pigmented without associated melanocytic proliferation. Slight fibrosis of upper dermis was identified [].\nConsidering clinical and histopathological findings, our patient highly probable, had NHNA.\nShe was reassured about the benign nature of the disease and was advised to use topical Mometasone furoate cream 0.1% (Elocom®) and emollient. One month later, she responded to therapy partially, with an acceptable cosmetic result []. In a period of 8 months follow-up, she experienced several recurrences and benefited from the prescribed topical steroid and emollient. However, she never had a complete clearance.