Nipple Inflammation
An inflammation of the nipple rarely occurs in isolation. In most cases there is an inflammation of the breast itself, more precisely of the glands inside the breast. Such an inflammation of the glandular bodies is called mastitis.
There are two types of mastitis. Mastitis puerperalis only occurs in women who have given birth days or a few weeks before, so it is a disease of the puerperium. Mastitis non-puerperalis, on the other hand, occurs independently of the puerperium.
Puerperal mastitis most often occurs in the second week after birth. The pathogen that causes the inflammation is usually Staphylococcus aureus and is transmitted during breastfeeding. The inflammation is usually only present in one part of the breast, often it is the upper outer quadrant of the breast.
The area is reddened, overheated, painful and swollen. The breastfeeding function is limited. There is a pronounced feeling of illness with fever and swollen lymph nodes in the armpit area of the affected side.
If the inflammation is not treated, an abscess may develop, which must then be treated surgically. Therapeutically, depending on the stage of the disease, cooling, immobilization with a tight bra and pumping out the milk are possible. The pumping out is done to prevent milk congestion, the milk is then discarded because it contains germs.
The administration of antibiotics in the early stages is quite useful. It is also possible that the milk production is inhibited by medication. If an abscess already exists, it must be punctured or split and emptied, depending on its size.
Mastitis non-puerperalis is a disease of the sexually mature but not pregnant woman, mostly before menopause. It can be caused by bacteria, with staphylococci being the most common triggering pathogens. But also non-bacterial mastitis can occur.
Reasons for this can include milk flow (galactorrhea), mastopathy or inverted nipples (inverted nipples). The increased milk flow can be triggered by hormones, medication or stress. The symptoms of mastitis non-puerperalis are similar to those of mastitis puerperalis.
In a circumscribed area of the breast, redness, overheating, painful pressure and swelling occur. A very important differential diagnosis is inflammatory breast carcinoma, a type of breast cancer. Here too, the breast is often reddened and overheated.
If the therapy does not respond or if the diagnosis is unclear in any other way, a biopsy may be taken for exact differentiation. Therapeutically, prolactin inhibitors are the most suitable treatment for mastitis non-puerperalis, as the frequently causative milk flow is caused by too much of the hormone prolactin. One drug from this group is bromocriptine.
The therapy should be continued for up to 6 weeks, otherwise a relapse can occur quickly. Cooling also relieves symptoms. Antibiotics are used in cases of bacterial mastitis non-puerperalis.
