It can be worrying when white spots appear on the nipples and the colored areas surrounding them, known as the areolas. Fortunately, white spots on the nipples and areolas are not a cause for concern on most occasions.
White spots often result from a blocked nipple pore when someone is breast-feeding, or as a normal reaction to changing levels of hormones within the body.
In this article, we look at the following possible causes of white spots on the nipples and areolas:
- pregnancy and hormone changes
- blocked nipple pores and ducts
- rarer conditions
We also look at symptoms, treatments, prevention, and when to see a doctor.
Montgomery glands are the main white spots that become more visible due to pregnancy and hormone changes.
Montgomery glands are present on both the nipple and the surrounding areola. They contain an oily substance that keeps the nipples soft and supple.
Scientists also believe that the smell of this oily substance encourages young babies to feed and helps them to locate the nipple when they first start breast-feeding.
A change in the size and number of Montgomery glands visible on the nipple and areola is one of the earliest signs of pregnancy. This can occur even before morning sickness or other pregnancy signs.
Montgomery glands can become filled with a waxy substance. The gland then resembles a pimple with a white or yellowish head. These spots are known as Montgomery tubercles.
Women do not have to be pregnant or breast-feeding for this to occur. Other female hormone changes can cause the same response.
The causes of female hormone changes include:
- the menstrual cycle
- the contraceptive pill
- the menopause
- another disorder
Treatment and prevention
Montgomery tubercles are harmless, and no treatment is necessary when these change or increase in number.
These spots should not be squeezed or popped as this can introduce infection.
People should see a doctor if they are worried by the appearance of white spots on their nipples or they are not sure why they have appeared.
Nipple pores are the openings of the nipple ducts that lead to the milk chambers in the breast where the female body stores breast milk.
When someone is breast-feeding, nipple pores and ducts can sometimes get blocked with milk. Symptoms and treatments vary, depending on the length of time they remain blocked.
When a nipple pore first becomes blocked, a white spot may appear on the nipple. This is also known as a bleb.
Blocked pores can be painful but are usually cleared by suction during a baby’s next feed.
If skin grows over the opening of the blocked nipple pore, a milk blister can form. The area around the white spot often starts to become red and inflamed.
When a nipple pore remains blocked, the milk duct leading from the milk chamber can also become blocked and inflamed.
A lump and swelling often form under the blocked nipple pore. Pain levels increase and breast-feeding can become very uncomfortable.
A blocked duct can lead to complications, such as mastitis and breast abscesses if it is not treated swiftly.
A blocked nipple pore will often clear naturally during the next feed.
When the nipple pore does not unblock on its own, the individual can take steps to help. These include:
- placing a warm compress on the breast and nipple before a feed
- using a cold compress after feeding to reduce discomfort
- taking a warm shower and gently rubbing the blocked nipple with a towel
- massaging the breast and nipple, taking care, as they bruise easily
- hand-expressing milk before the feed to soften the breast
- directing the infant to feed from the affected breast first
- positioning the baby’s lower jaw near to the lump caused by a blocked duct
- using pain relief, such as acetaminophen or ibuprofen, to reduce discomfort
When skin grows over the nipple pore and a milk blister forms, the above treatments may not always unblock the nipple pore. People should seek advice from a doctor or midwife if this happens.
The pore may need to be reopened using a sterile needle to break through the skin. A person who does this should take great care, as they can introduce infection into the nipple and breast.
Some simple steps can be taken to help prevent blocked nipple pores and ducts. These include:
- making sure each breast is emptied completely during feeding before swapping to the other breast
- ensuring that the baby is latching on correctly
- wearing a bra that fits correctly
- avoiding underwired bras and tight-fitting straps
- avoiding wearing tight clothes
- positioning seat belts and baby carriers so that they do not restrict the breasts
- altering the position of the baby on the breast each feed
If blocked pores and ducts keep occurring, people should seek advice from someone with appropriate training who can check that the baby is positioned and latched on correctly.
A person should seek medical advice if any of the following occur:
- their breast becomes red or inflamed
- they feel unwell
- they develop a high temperature
- they are worried about symptoms they have
In these instances, mastitis or an infection may be present.
Less frequently, an infection causes white spots on the nipples. Infections may be due to a fungus, virus, or bacteria.
Although anyone can develop an infection on the nipples, breast-feeding mothers and people with weakened immunity are most at risk.
Infections of the nipples that can cause white spots include:
- subareolar abscesses
Thrush is a fungal infection that is most common in the vagina. It is also known as a yeast infection. Newborn babies can develop thrush in the mouth and then infect the broken and cracked skin of their mother’s nipples when breast-feeding.
The symptoms of thrush are a white rash, followed by red, sore, and inflamed skin on the nipples.
The herpes simplex virus causes herpes. Herpes is a sexually transmitted disease that the mother can pass from the birth canal to the newborn’s mouth and eyes. The newborn may then spread the virus to the mother’s breasts.
The symptoms of herpes are fluid-filled blisters that form scabs when they burst.
Subareolar abscesses are buildups of pus in the breast tissue that are caused by bacterial infections. They are not common and are often a result of poorly treated mastitis.
These abscesses are not always linked with breast-feeding and can also be caused by bacteria that enter the breast tissue through a wound, such as acne or a nipple-piercing.
The symptoms of a subareolar abscess are a painful lump with discolored and swollen skin.
If someone thinks that they may have an infection of their nipples or breasts, they should seek medical advice from a doctor. Each infection requires different treatments.
For yeast infections, mother and baby are treated with antifungal medication.
Herpes can have serious consequences for the baby’s health, and so swift treatment is vital. A week of antiviral medication is usually given to both mother and baby.
Subareolar abscesses often require a course of antibiotics. Sometimes, if they do not heal, an operation to drain pus from the breast tissue or completely remove a duct is necessary.
Additional causes of white spots on the nipples that are less common include:
- Vitiligo: An autoimmune disorder that destroys the body’s pigmented cells.
- Paget’s disease: A very rare form of breast cancer, with symptoms similar to eczema, that starts in the areola and nipples.
Pregnancy and breast-feeding frequently cause white spots on the nipples and areolas of the breasts. Some spots may be caused by infection or other serious conditions, however.
Breast cancer is the most common cancer and the second highest cause of cancer deaths among women in the United States. The recommended method of improving breast health and reducing the risk of breast cancer is being aware of and recognizing changes to the breasts.
If someone is concerned about their breasts or nipples and any changes to them, they should always seek medical advice from a doctor.