EpistemisPersistent peeling or eczema of the nipple
Specialty: Gynecology and breast.
Why it occurs
- Contact dermatitis (due to bra fabrics, soaps or perfumes)
- Atopic dermatitis of areolar location
- Paget's disease of the breast (intraepithelial carcinoma usually associated with underlying ductal carcinoma in situ or invasive)
- Fungal infection (areolar candidiasis or ringworm)
- Psoriasis located in the breast
Initial workup
Microbiological smear for bacterial and mycological culture if there is clear infectious suspicion. High-resolution bilateral mammography and breast ultrasound to evaluate the presence of underlying parenchymal lesions or microcalcifications. Full thickness biopsy of the nipple (punch or incisional biopsy) for histological study with immunohistochemical stains (Paget cells positive for CK7 and HER2).
red flags
Unilateral lesion, progressive destruction of the nipple, peeling that extends to the areola, presence of serous or bloody exudate, focal ulceration, lack of therapeutic response after the use of topical corticosteroids of moderate potency for 10-14 days.
Standard management
- Hydrocortisone 1% cream applied once a day for a maximum of 7 days — only if simple contact eczema is suspected; discontinue if there is no rapid improvement
- Clotrimazole 1% cream applied every 12 hours for 10 days if candidiasis is suspected (note: prolonged use of powerful topical corticosteroids is contraindicated without a confirmatory diagnosis due to the risk of delaying the diagnosis of Paget's Disease).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Gynecology and breast
- Listed causes
- 5
- Treatment options
- 2