- 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.
- Destruction of the nipple.
- Inversion of the nipple.
- Sometimes palpable breast lump.
- 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.
Paget’s disease of the nipple causes eczema-like change
Eczema of the nipple may be present during lactation
ECZEMA OF THE NIPPLE
- Often history of atopic eczema with personal or family history of hay fever or asthma.
- Allergic response to contact allergen.
- May present during lactation.
- Acute inflammation, weeping vesicles or blisters.
- Chronic problems with dry, thickened areas.
- Nipple preserved.
- No breast lump.
- Avoid aggravating cause.
- 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.