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.



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?



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?



Welcome back to icliniq.com.

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

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