Herpes Simplex Virus Infections of the Nipple

Abstract

The usual sites of herpes simplex virus (HSV) type 1 and 2 infections are orolabial and anogenital, respectively. HSV infection of the nipple and periareolar area is exceptional but probably underrecognized. Typical features include severe pain and erosive or ulcerated erythematous confluent clusters of lesions of the nipple and periareolar area. It is usually unilateral and not recurring. HSV infection of the nipple is originating from autoinoculation, sexual transmission or breastfeeding. Diagnosis is often delayed. The Tzanck smear is the most rapid and adequate method of diagnosis. Immunohistochemistry enables viral identification. The treatment relies on topical disinfection and oral antiviral therapy, such as aciclovir, famciclovir or valaciclovir. Scarring is uncommon.