Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Letter To Editor
2006:72:5;384-386
doi: 10.4103/0378-6323.27762
PMID: 17050940

Nevoid hyperkeratosis of nipple: Nevoid or hormonal?

Siddhi B Chikhalkar, Rachita Misri, Vidya Kharkar
 Department of Dermatology, Seth GSMC and KEM Hospital, Mumbai - 400 012, India

Correspondence Address:
Siddhi B Chikhalkar
Department of Dermatology, Seth GSMC and KEM Hospital, Parel, Mumbai - 400 012
India
How to cite this article:
Chikhalkar SB, Misri R, Kharkar V. Nevoid hyperkeratosis of nipple: Nevoid or hormonal?. Indian J Dermatol Venereol Leprol 2006;72:384-386
Copyright: (C)2006 Indian Journal of Dermatology, Venereology, and Leprology
Papillomatosis and acanthosis (H and E, 200x)
Papillomatosis and acanthosis (H and E, 200x)
Pretreatment (a) and post-treatment (b) photographs of palms and soles
Pretreatment (a) and post-treatment (b) photographs of palms and soles

Sir,

We read with the interest the article "Nevoid hyperkeratosis of nipple - a report of two cases" in your journal recently.[1] We hereby report a case of nevoid hyperkeratosis of nipple and areola (HNA). We were intrigued by the term ′Nevoid′ and hence try to debate as to how appropriate is the use of this terminology. Also, till date only two cases of nevoid hyperkeratosis of nipple have been reported from India.[1],[2]

A 21-year-old female presented to us with asymptomatic brown-colored rough raised lesions on both the nipples since the age of 13 years. The lesions increased in size during pregnancy. There was no history of pruritus, alteration in the lesion with menstrual cycle and complications such as ulceration, bleeding, discharge, pain or retraction of nipple. There was no history of any other skin lesions at that site.

On examination both the nipples were covered with diffuse, hyperpigmented, verrucous and hyperkeratotic plaque [Figure - 1]. No associated anomalies of the nipples and breast were seen. The skin biopsy of the lesion showed irregular acanthosis and papillomatosis with increased melanization of keratinocytes. Melanocytes were normal in number [Figure - 2]. Based on clinical and histopathological features we reached the diagnosis of nevoid hyperkeratosis of the nipple. Since the patient was pregnant (five months gravida) we counseled her and advised follow-up after delivery for treatment.

HNA is a rare clinical condition. Initially described in 1923,[2] HNA is classified into three categories according to the classification proposed by Levy-Frenckel in 1938:[3],[4] Type I: associated with an epidermal nevus, Type II: associated with other dermatoses (congenital, acquired or erythrodermic ichthyosis, acanthosis nigricans, Darier′s disease, chronic eczema, cutaneous T-cell lymphoma) and Type III: (Nevoid HNA), of unknown etiology, an isolated finding.

Considering the above classification, our patient had Type III HNA. Amongst the various types, nevoid form of the disease is extremely rare, usually seen in women in the second or third decade of life. There are doubts on whether nevoid hyperkeratosis of the nipple and areola is a distinct entity or a clinical presentation of various dermatoses. Type III HNA is seen in females at puberty, those of childbearing age, pregnancy and also in males receiving hormonal therapy for prostate cancer.[5],[6] It may also be seen in females and males without the above mentioned conditions. Pregnancy may increase the size of the lesions. Since our patient′s condition began at puberty and worsened during pregnancy the term hormonal hyperkeratosis of nipple would be more apt.

Even Mehanna et al .[7] suggested that Type I should not be considered as HNA as it is associated with the epidermal nevus and hence the term should be reserved for only Types II and III. They also suggested that the term ′nevoid′ be replaced by ′idiopathic′. The term nevoid[8] (nevus-like) means odd or abnormal that stems from a heritable or embryogenic fault. So one really wonders whether the term nevoid is truly applicable here and hence revision of the term has to be considered. Hence we support the view of Mehanna et al. that the term nevoid should not be used for the Type III variant of HNA.

Perez-Izquierdo et al .[9] proposed an alternative classification of two types:

1. Idiopathic or nevoid

2. Secondary to other dermatoses.

The main cause of concern for patients of HNA is the cosmetic appearance of the nipple and areola. Patients should be asked to look out for any changes in the breasts. They should be counseled about the condition and the treatment that may take a long time. Treatment with one of the medications as mentioned by Veeranna et al .[1] should be continued for at least six months before it is considered a failure. Sometimes lesions recur and in some patients lesions don′t respond to treatment.[3] Since our patient was pregnant, counseling was done and we asked the patient to follow up for treatment after delivery.

References
1.
Veeranna S, Betkerur J, Kushalappa PA. Unilateral nevoid hyperkeratosis of the nipple: A report of two cases. Indian J Dermatol Venereol Leprol 2006;72:303-5.
[Google Scholar]
2.
Baykal C, Buyukbabani N, Kavak A, Alper M. Nevoid hyperkeratosis of the nipple and areola: A distinct entity. J Am Acad Dermatol 2002;46:414-8.
[Google Scholar]
3.
Revert A, Banuls J, Montesinos E, Jorda E, Ramon D, Torres V. Nevoid hyperkeratosis of the areola. Int J Dermatol 1993;32: 745-6.
[Google Scholar]
4.
Burns DA. The Breast, In: Tony Burns, Breathnach S, Cox N, Griffith C, editors. Rook's Textbook of Dermatology, 7th ed. Blackwell Science: New York; 2004. p. 67.8-9.
[Google Scholar]
5.
Kubota Y, Koga T, Nakayama J, Kiryu H. Naevoid hyperkeratosis of the nipple and areola in a man. Br J Dermatol 2000;142: 382-4.
[Google Scholar]
6.
English JC 3rd, Coots NV. A man with nevoid hyperkeratosis of the areola. Cutis 1996;57:354-6.
[Google Scholar]
7.
Mehanna A, Malak JA, Kibbi AG. Hyperkeratosis of the nipple and areola: Report of 3 cases. Arch Dermatol 2001;137:1327-8.
[Google Scholar]
8.
Leider M, Rosenblum M. A dictionary of dermatological words, Terms and phrases. McGraw Hill Book Company: New York; 1968. p. 297.
[Google Scholar]
9.
Perez-Izquierdo J, Vilata J, Sanchez J, Gargallo E, Millan F, Aliaga A. Retinoic treatment of nipple hyperkeratosis. Arch Dermatol 1990;126:687-8.
[Google Scholar]

Fulltext Views
1,804

PDF downloads
336
Show Sections