Treatment of Nevoid Hyperkeratosis of the Nipple and Areola by Shave Excision

Abstract

The case is presented of a 29-year-old female who, at the age of 13 years, developed bilateral verrucous thickening of her areolae. Despite the condition causing her significant psychosocial morbidity, a specialist referral was initially denied on the grounds that no treatment was apparently available. The condition progressively deteriorated over the subsequent 14 years. She was eventually referred for a dermatology opinion, and the diagnosis of nevoid hyperkeratosis was made. Topical therapy with keratolytics was unsuccessful, and she was referred for a plastic surgery review. Bilateral shave excision of the lesion was performed under general anesthesia, with a satisfactory outcome and no evidence of recurrence at 10 months.

Focal nevoid hyperkeratosis of the nipple in a prepubertal girl

“…Unfortunately, most of the lesions recur after cessation of treatment. Ablative therapies have been reported such as cryotherapy, surgical excision, carbon dioxide laser, or radiofrequency, also with variable results …”

Hyperkeratosis of nipple and areola

“…Various keratolitic agents like retinoic acid5 and calcipotriol [7] are found effective. Simple shave excision [8], radiofrequency [9], cryotherapy and co2 laser [10] is also effective. …”

Pregnancy-Associated Hyperkeratosis of the Nipple

“…19 A sustained remission of HNA has been maintained with low-dose acitretin combined with calcipotriol. 7 Surgical modalities, such as cryotherapy, 9 shave excision, 28 surgical removal, 29 carbon dioxide laser, 30 and radiofrequency ablation, 31 have been used in unresponsive cases of HNA and might also find utility here. Symptomatic, recalcitrant lesions showed a complete response to curettage in 1 of our patients.…”