A 28-year-old woman in her 5th month of pregnancy presented with a 2-month history of asymptomatic, irregular thickening of both nipples and the left areola. On physical examination, both nipples and the left areola were covered with diffuse, hyperpigmented, verrucous plaques with a filiform or papular warty surface (A). Histologic examination revealed orthokeratotic hyperkeratosis, irregular filiform acanthosis, papillomatosis, and keratotic plugging (B, hematoxylin and eosin), all of which are found in nevoid hyperkeratosis of the nipple and areola. The lesions are benign and asymptomatic and thus may not come to medical attention. The cause of nevoid hyperkeratosis of the nipple and areola is unknown. Eighty percent of cases occur in women and are often manifested during puberty or pregnancy. The disease may also occur in men receiving hormonal therapy.
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