Women's Health Community

Dear girlconfused: Paget's Disease (PD) is a rare form of breast cancer that can involve both the nipple and the aerola (colored area that encircles the raised nipple). While being the least common cause of nipple symptoms, it is the most worrisome. So let's discuss it first.

An itching or burning sensation of the nipple or aerola is a common initial symptom; it is often accompanied by a crusted appearance. Persisting soreness/itching with a scaly, eczema-like rash, that does not improve despite prescription treatment, is highly suspicious for Paget's.One may also have a yellow or blood tinged nipple discharge from the effected side. In later stages there can be an ulcer or mass in the areola. Most often, PD involves only one breast. Thus it is not usually linked to bilateral nipple itching or rashes. The peak incidence of PD occurs in women between the ages of 50 and 60 .

PD is diagnosed with a clinical breast exam, thorough patient history, mammogram, and an ultrasound if indicated. If there is still a suspicion, despite a normal exam and mammogram, a MRI can be utilized to identify PD. A breast biopsy of the nipple will provide tissue to be sent to pathology for a microscopic examination and conclusive diagnosis. Any coexisting lumps would be biopsied as well.

Another non-cancerous condition, neurodermatitis can also elicit bruning/itching. Neurodermatitis is known by a variety of names including "lichen simplex chronicus", or more descriptively "itch scratch phenomena". It starts with an irritation which could be eczema, atopic dermatitis, a fungal infection, or even rubbing by clothing. Chronic itching and scratching create a cycle of continued irritation as nerve endings are stimulated. The result can be a roughened, thickened area of skin. While the extremities are common sites I have certainly seen neurodermatitis on the vulva. It can also be found on the nipple—usually one side only (Novick, 2001). Neurodermatitis is more common among women, and is more prevalent between the ages of 30-50 (Domino, 2007).

Diagnosis is by ruling out other sources of itching. A skin biopsy might be done to confirm neurodermatitis if there has not been a response to other skin treatments. Since neurodermatitis can be exacerbated during times of stress and anxiety a person may be asked about their current stressors.

Your best bet is to have a focused breast exam done by a GYN. They can give you the most "for sure" answer, and order additional testing if needed.

Yours,
Jane

Thank you for the information Ms. Hohner. I recently had a breast exam and there is no rash, itching, crusted appearance, or discharge. The only thing that has changed is the color and sensitivity. I have very pale skin and before my breast where a pale pink now they have changes to a light brown. It almost looks like they have been tanned, but I do not lay out in the sun or in tanning beds. Could this be a hormonal issue?