Bilateral nipple hyperkeratosis treated successfully with topical isotretinoin

A 22-year-old woman presented with bilateral thickening and hyperpigmentation of her nipples since the age of 17 years. There was no history of pregnancy or oral contraceptive pill use. Isotretinoin 0.025% gel was applied twice daily and the lesions disappeared in 4 weeks. After the drug was ceased, recurrence appeared within 4 months. The same therapy, applied for 2 weeks, again cleared the problem.