Nipple and Skin Changes

Nipple and skin changes refer to visible differences in the appearance of the nipple or the skin of the breast. These can involve the nipple turning inward, becoming scaly or crusted, or changing position, as well as changes in the breast skin such as dimpling, puckering, redness, thickening, or a texture resembling the peel of an orange. Some of these changes are harmless and long-standing, while others can be an important early sign of an underlying breast condition. Because certain skin and nipple changes are among the more noticeable signs of breast cancer, any new or unexplained change is worth having checked.

Many nipple and skin changes are benign, while a smaller number point to an underlying condition. Possible causes include:

• A nipple that has been turned inward since youth, which is normal, or skin conditions such as eczema or dermatitis that cause redness and scaling.
• Previous surgery, infection, or duct ectasia (a widened milk duct), which can alter the appearance of the nipple.
• A nipple that newly turns inward or shifts direction, which can happen when an underlying tumor pulls on the tissue.
• Persistent scaling, crusting, or a rash on the nipple, which may be a sign of Paget disease of the nipple, an uncommon form of breast cancer.
• Dimpling or puckering of the skin, which can occur when a tumor tethers the tissue beneath it.
• Redness, warmth, swelling, and an orange-peel texture across the breast, which can indicate inflammatory breast cancer and require urgent assessment, although a simple breast infection can cause similar changes.

Because some of these changes are harmless and others are not, any new or unexplained change is best checked rather than watched.

Medical advice should be sought for any new nipple or skin change that does not have an obvious, harmless explanation. This includes a nipple that has newly turned inward, persistent scaling or crusting of the nipple, and dimpling or puckering of the breast skin. Redness, swelling, or warmth of the breast that does not settle quickly — especially if it is not clearly due to an infection — should be assessed without delay, as should an orange-peel appearance of the skin. While many of these changes have benign causes, prompt evaluation ensures that the few that signal a serious condition are identified and treated as early as possible.