Q. I have dry, cracked nipples on both sides. Could it be Paget's disease?

Answered by
Dr. Payal Chauhan
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jan 13, 2021

Hello doctor,

I have dry, cracked nipples and not sure if it is normal.

#

Hello,

Welcome to icliniq.com.

I understand your concern.

Looking at the photograph (attachment removed to protect patient identity), there can be two differentials, nipple eczema or Paget's disease of the breast.

Pagets is a more severe condition out of this, so I would recommend a skin biopsy as soon as possible to rule it out.

Thank you doctor,

It affects both breasts and has been like this for a long time. E45 helps reduce the build-up of dry skin, but it still looks cracked even after moisturizing a lot. I have never had eczema and do not suffer from dry skin. Could it be a yeast infection? I thought Pagets only affects one breast. I have it on both, so does this rule Pagets out?

#

Hi,

Welcome back to icliniq.com.

Yes, it is extremely rare for Pagets to be bilateral but reported. Differentials would be eczema and Pagets lower down, but you should go for a biopsy if it is not improving.

Try taking weekly Fluconazole 150 gram for two weeks. If not already tried and a combination of Clotrimazole with Beclomethasone like Candid-B cream for 10 to 14 days will cover both eczema and possible fungal infection.

Fungal infection can easily be ruled out by a superficial KOH smear if available nearby. But yes, it is extremely rare for the Pagets to be bilateral. Only a few reports are there in the literature.

Thank you doctor,

Try taking weekly Fluconazole 150 gram for two weeks, is it only one tablet a week?

#

Hi,

Welcome back to icliniq.com.

Yes, one tablet per week for two weeks. So total two tablets.


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