Crusting on the nipple is a common physical symptom defined by the accumulation of dried fluid, dead skin cells, or other debris on the nipple and areola. While the appearance of a crusty nipple can be concerning, the causes span a wide spectrum, with most being benign and easily resolved. Understanding the nature of the crust—whether it is dry and flaky, or wet and oozing—can help narrow down the potential origin. This information is not a substitute for professional medical diagnosis or treatment.
Common External Contributors
Simple environmental or mechanical factors are often responsible for nipple crusting, representing the most common causes. Friction is a frequent culprit, particularly in athletes who experience “jogger’s nipple” from rough fabric rubbing against the skin during prolonged activity. This mechanical irritation causes the skin to become dry, cracked, and sometimes scabbed, leading to a crusty appearance.
Hygiene products can also leave behind residue that contributes to crust formation. Incomplete rinsing after showering may leave dried soap or laundry detergent particles on the skin, which then mix with natural skin oils and sweat. Individuals who are pregnant or breastfeeding may also notice crusting due to dried colostrum or breast milk on the nipple surface. These protein-rich fluids dry into a visible, typically harmless crust.
Inflammatory Skin Conditions
When crusting is persistent and accompanied by symptoms like itching or redness, an underlying inflammatory skin condition may be the cause. Atopic dermatitis (eczema) can affect the nipple and areola, causing the skin barrier to break down. This leads to chronic dryness, scaling, and the formation of small bumps that may weep fluid and eventually crust over.
Contact dermatitis occurs when the nipple is exposed to an irritant or an allergen, such as fragrances, dyes in laundry detergent, or topical creams. The resulting inflammation manifests as a localized, itchy rash that may develop scaly, crusty patches upon repeated exposure. Psoriasis, another chronic skin condition, can also affect the nipple area, though less commonly than dermatitis, typically presenting as thicker, more defined patches of scaly, crusted skin.
Signs of Infection and Serious Conditions
While most causes are benign, crusting can sometimes signal an infection or, rarely, a serious medical condition that requires immediate attention. Infections of the nipple and breast tissue, such as bacterial cellulitis or mastitis, often present with systemic symptoms like fever, localized pain, swelling, and warmth. The crusting in these cases is typically due to dried pus or discharge from a crack or fissure in the skin.
Fungal infections, such as thrush caused by Candida albicans, are common, especially in individuals who are breastfeeding or have recently taken antibiotics. This infection causes a burning or stinging sensation, and the skin may appear flaky or shiny, often with visible crusting. Infections must be treated promptly with appropriate medication to prevent further complication.
In rare instances, persistent crusting and scaling can be a sign of Paget’s disease of the breast, a rare form of cancer involving the skin of the nipple and areola. This condition often mimics common skin issues like eczema, but it typically affects only one breast and does not clear up with standard topical treatments. Symptoms can include a flattened nipple, bloody or yellowish discharge, a burning sensation, or a noticeable lump in the breast tissue.
Inflammatory breast cancer, another rare condition, can present with skin changes like thickening, pitting that resembles an orange peel (peau d’orange), or a persistent rash, which may be mistaken for a simple infection or dermatitis.
When to Consult a Healthcare Provider
A visit to a medical professional is warranted if the crusting persists despite basic hygiene changes or self-care measures. It is important to seek evaluation if the crusting is limited to only one nipple, as unilateral symptoms raise suspicion for underlying pathology, including Paget’s disease. Any new or unexplained discharge from the nipple, especially if it is bloody, clear, or yellow, should be reported to a doctor.
Other concerning signs that necessitate a medical consultation include pain, tenderness unrelated to the menstrual cycle, or any palpable lump or mass in the breast tissue. Additionally, a new change in the shape of the nipple, such as a sudden inversion or retraction, or the presence of a fever alongside breast symptoms, should prompt professional advice. Timely evaluation ensures an accurate diagnosis and appropriate treatment plan.