At a Glance - Paget's disease of the nipple vs eczema of the nipple

Paget's Disease of the Nipple.

Clinical features

  • Occurs almost exclusively in women.
  • May occur at any age from 24 to 84, although it is most common around the menopause.
  • Almost always associated with underlying carcinoma of the breast.
  • Unilateral, persistent eczematous-type change of the nipple with erythema and scaling.
  • Itching or burning sensation.
  • Discharge and/or bleeding from the nipple.
  • Ulceration.
  • Destruction of the nipple.
  • Inversion of the nipple.
  • Sometimes palpable breast lump.

Management

  • Investigations - mammogram, cytology of scrape from the nipple.
  • Punch, wedge or excisional biopsy.
  • Urgent referral to breast unit.
  • Local excision or mastectomy, chemotherapy and/or radiotherapy.

 

Photograph: SPL/ M A ANSARY

Paget’s disease of the nipple causes eczema-like change

Eczema of the nipple may be present during lactation

ECZEMA OF THE NIPPLE

Clinical features

  • Often history of atopic eczema with personal or family history of hay fever or asthma.
  • Allergic response to contact allergen.
  • May present during lactation.
  • Bilateral.
  • Irritation.
  • Acute inflammation, weeping vesicles or blisters.
  • Chronic problems with dry, thickened areas.
  • Nipple preserved.
  • No breast lump.

Management

  • Avoid aggravating cause.
  • Moisturisers.
  • Topical corticosteroid cream or ointment.
  • Oral antihistamine if itching is troublesome.
  • Patch testing if allergen suspected.
  • Mammogram, cytology or biopsy if necessary.

Contributed by Dr Jean Watkins, a sessional GP in Hampshire.

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