Real-World Prevalence and Associated Factors of Nipple Eczema in Patients With Atopic Dermatitis

Nipple eczema (NE) manifests as pruritic or painful erythema, often accompanied by oozing, erosion, and lichenification. NE is observed in 6%-23% of patients with atopic dermatitis (AD); its prevalence is higher among adolescent and young adult women.

To determine the prevalence and clinical correlates of NE in patients with AD.

We conducted a retrospective cross-sectional study from July to December 2023, enrolling patients diagnosed with AD. Participants completed a questionnaire regarding their symptoms of AD and NE, as well as the impact of NE on their daily lives.

Of the 200 patients, 55 (27.5%) reported of having experienced NE. The mean age at NE onset was 22.75±9.77 years. The proportion of females with NE (70.9%) was significantly higher relative to those without NE (38.6%) (p<0.001). Factors significantly associated with the presence of NE in AD patients included female sex (odds ratio [OR], 4.90; 95% confidence interval [CI], 1.99-12.07; p=0.001), increased AD itch numerical rating scale (NRS) score (OR, 1.46; 95% CI, 1.11-1.91; p=0.007), increased AD pain NRS score (OR, 1.20; 95% CI, 1.01-1.44; p=0.041) and higher Investigator Global Assessment score (OR, 5.38; 95% CI, 2.07-13.99; p=0.001). Regarding nipple-specific health-related quality of life (HRQoL), 35.8% of patients reported severe impairment in HRQoL due to NE, and 45.3% experienced severe emotional distress.

Although the area affected by NE is small, dermatologists should be aware of its association with severe AD characteristics, and its significant impact on patient HRQoL.