Although psoriasis can occur anywhere on the body, it rarely develops on the nipples. Other skin disease symptoms on the nipples can resemble psoriasis, so it’s important to know whether these symptoms are indeed from psoriasis or another medical condition.

Although uncommon, psoriasis on the nipples can take a toll on the quality of your life. It can be distressing if psoriasis or another skin condition occurs in a delicate area such as your nipples or genitalia. It’s essential to get an accurate diagnosis and appropriate treatment.

“OMG I’m miserable 😭. My skin burns, and it hurts to bathe. I even broke out on my nipples. I’m covered,” wrote a MyPsoriasisTeam member.

Another said, “Plaque psoriasis on elbows, buttocks, groin and private area, knees, legs, inside nose, nipple, and about 75 percent of my scalp.” Another member expressed similar aggravation: “I’m somewhat frustrated with all this psoriasis. It’s all over: head, arms, fingers, legs, and nipples.”

Psoriasis on the nipple and the areola — the darker skin that surrounds the nipple — is not classified as a particular type of psoriasis. Although very little medical research specifically addresses psoriasis of the nipples, some clinical documentation (health care providers’ notes in people’s medical records) suggests it’s likely a form of localized plaque psoriasis, the most common type of psoriasis.

Psoriasis is a disease that causes skin cells to rapidly reproduce, leading to thickened skin plaques that become inflamed, because of dysfunction in the immune system. Symptoms of plaque psoriasis on the nipple may include dry skin and discolored patches, with white scales that can be itchy or painful.

Genital psoriasis and psoriasis that occurs under the breasts, in the armpits, and in other moist skin folds is usually a type of inverse psoriasis, also known as flexural psoriasis. Inverse psoriasis is characterized by smooth, discolored skin (purplish, brown, or red, depending on your natural skin tone), rather than skin with white or silvery scales.

Symptoms are typically managed with topical psoriasis treatments, including corticosteroids, topical immunomodulators, ultraviolet light therapy and other types of phototherapy, immunosuppressive drugs, or biologic medications — depending on the severity. If you have a rash on your nipples that appears to be psoriasis, be sure to discuss treatment options in detail with your doctor.

Psoriasis on the Nipples and Breastfeeding

People with psoriasis are susceptible to a condition called the Koebner phenomenon, which can cause new lesions to form on previously clear areas if skin is scratched, injured, or irritated, even lightly. The soreness and stress that can come with breastfeeding a baby may cause the Koebner phenomenon, with psoriasis lesions forming on the nipples and areola.

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One MyPsoriasisTeam member shared their experience of developing psoriasis on the nipple from breastfeeding. “My worst problem was with breastfeeding, as my cracked nipples developed psoriasis, which lasted for years and years,” they said.

Psoriasis is not contagious and cannot spread to a baby through breastfeeding, but an outbreak on the nipple could make breastfeeding uncomfortable or painful and worsen the condition. This area can also get infected when the skin barrier is disrupted.

Treating Psoriasis on Nipples

Psoriasis can be managed with treatments to help control symptoms and flare-ups, including on the nipples. If you’re experiencing psoriasis on the nipples, talk to your dermatologist about topical treatments that are appropriate for sensitive, thin skin.

It’s a good idea to test over-the-counter moisturizers, creams, and lotions with compounds such as salicylic acid or coal tar on a small patch of affected skin before using them. This will protect you in case you have a reaction or an unpleasant side effect.

Your doctor may recommend systemic treatments — medications that are taken orally (by mouth) or by injection — to treat underlying disorders in the immune system. However, if you are planning a pregnancy, it’s important to discuss treatment options that will be safe during pregnancy, particularly in the first trimester.

If you’re treating psoriasis on the nipple while breastfeeding, be sure to talk with your doctor about topical treatments that are safe for your infant. Steroid creams or ointments applied to the nipple area could be absorbed by your baby. Some of the newer creams do not contain steroids, but their safety regarding breastfeeding is unknown. Review any topical treatments in detail with your health care team before use when breastfeeding.

The National Psoriasis Foundation also recommends avoiding systemic psoriasis medications while breastfeeding because there is limited research on how these drugs may affect infants.

Diagnosing Psoriasis on Nipples vs. Other Skin Diseases

Psoriasis on the nipples is rare, so if you have a rash that resembles psoriasis, your dermatologist may try to determine if it might be another skin condition. Psoriasis on the nipple is diagnosed by examining affected areas, reviewing family history, and checking for symptoms. Your doctor may also ask about joint pain, which may indicate psoriatic arthritis, a condition that occurs in approximately 30 percent of people with psoriasis. Your doctor may want to perform a skin biopsy (take a small tissue sample) to examine skin cells under a microscope.

Other skin conditions on the nipples that may look like psoriasis include nipple eczema, nipple candidiasis, and Paget’s disease of the breast.

Eczema

Eczema is a common skin condition that can cause different types of rashes. Eczema on the nipples can be discolored, scaly, and itchy. It may affect both the nipple and areola. Infants and children are particularly prone to eczema on the nipple, but it can also occur in adults (both male and female). Eczema cannot be cured, but symptoms are typically managed with topical treatments and — in more severe cases — systemic medications.

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Candidiasis

Candidiasis is a fungal infection caused by Candida, a type of yeast. Fungi and yeast generally need warm, moist conditions to thrive, and candidiasis can occur with breastfeeding. Babies can get thrush, an oral form of candidiasis that can be passed from the infant’s mouth to the parent’s nipple. Yeast infections in the nipple can cause stabbing pain, itchiness, discoloration, and a flaky or dry areola. Candidiasis is treated with topical and oral antifungal medications.

Paget’s Disease of the Breast

Paget’s disease of the breast is a type of breast cancer. This rare disease, which starts in the nipple and usually spreads to the areola, typically develops after age 50.

Paget’s disease of the breast causes itchiness, discoloration, and scaling skin usually only on one breast. Other distinctive symptoms include a flattened nipple, yellowish or bloody discharge from the nipple, and a lump in the breast.

Treatment usually includes surgery to remove the cancer, followed by chemotherapy, radiation, or hormone therapy.

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Have you experienced psoriasis on your nipples? What has helped you manage your symptoms? Share your experience in the comments below, or start a conversation by posting on your Activities page.