Atopic dermatitis exclusively localized on nipples and areolas

Area of Science:

• Dermatology
• Pediatrics
• Allergology

Background:

• Celiac disease is an autoimmune disorder.
• Atopic dermatitis (AD) is a common inflammatory skin condition in children.
• Nipple eczema is an uncommon presentation of skin conditions.

Observation:

• An 11-year-old girl with celiac disease presented with a 9-month history of itchy, erythematous, and edematous lesions with vesicles and exudation on her nipples and areolas.
• No other lesions or signs of scratching were observed on her face or body folds.
• She had no prior history of atopic dermatitis lesions in typical sites or elsewhere.

Findings:

• Patch testing revealed positive reactions to nickel and thimerosal, but these were not clinically relevant to her presentation.
• The patient's presentation was consistent with a minor diagnostic criterion for atopic dermatitis.
• Nipple eczema was the primary manifestation, despite the absence of typical AD signs.

Implications:

• This case highlights the clinical significance of nipple eczema as a potential indicator of atopic dermatitis, even with atypical presentations.
• It emphasizes the importance of considering nipple eczema in the differential diagnosis of pediatric skin conditions, particularly in patients with underlying autoimmune disorders like celiac disease.
• The findings contribute to understanding the diverse clinical spectrum of atopic dermatitis and its diagnostic criteria in pediatric populations.