A 29-year-old woman (gravida 3, parity 3) at 20 weeks of gestation presented with skin growth at bilateral nipples and areola for past 5 years. It was first noticed during her first pregnancy. The lesions were gradually increasing in size, otherwise asymptomatic. Previously, she had difficulty to breastfeed twins from her second pregnancy. She has no known medical illness. She denied personal and family history of atopy. Physical examination revealed verrucous hyperpigmented plaques on bilateral areola and nipples. No genital or mouth lesion was seen.
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