Paget disease of the breast is an uncommon condition that affects the skin of the nipple, and often the darker ring around it, the areola. It usually appears on one side only. Although it looks at first like a simple skin problem, it is important because it is often linked to breast cancer inside the breast.
A rash that seems minor can be hard to take seriously. This guide explains what Paget disease is, what it looks like, why it is often mistaken for eczema, and how doctors check it, so you know when a nipple change should be looked at properly.
What Paget Disease of the Breast Is
Paget disease of the breast happens when cancer cells grow into the skin of the nipple. It most often starts in the milk ducts beneath the nipple and spreads to the skin surface, which is why the first signs appear as changes in the nipple itself.
It is a rare condition, accounting for a small share of breast cancers, and it most often affects women in their fifties and beyond, though it can occur at other ages. Men can also develop it, though much less often.
Unlike many breast conditions, Paget disease rarely causes a lump or pain deep in the breast at the start. The nipple itself is the message, which is why changes there should never be dismissed as merely a skin nuisance.
Symptoms on the Nipple and Areola
The signs usually begin on the nipple and spread slowly onto the areola. The skin may become red, flaky, crusted, or scaly, and it may itch, tingle, or burn. Some people notice a sore that weeps slightly or bleeds, or a straw colored discharge from the nipple.
The nipple may look flattened, and over time the sore can form a crust that falls away and then returns. A key feature is that these changes affect one nipple only, and they keep coming back or slowly worsen rather than clearing away.
How It Is Linked to Cancer Inside the Breast
In most cases, Paget disease is found together with breast cancer inside the same breast. That cancer may be ductal carcinoma in situ, where abnormal cells are inside the ducts, or an invasive cancer that has grown beyond the ducts.
Sometimes a lump can be felt, but often there is no lump at all, and the nipple change is the only outward sign. This is why doctors always look deeper when Paget disease is suspected, even when the breast feels normal.
Why It Is Often Mistaken for Eczema
Eczema on the nipple is common and harmless, and it looks very similar. Itching, redness, and flaking from Paget disease can be nearly identical at first glance, and many people understandably treat it with creams for some weeks before seeing a doctor.
There are differences worth knowing. Eczema often affects both nipples, often comes and goes, and usually settles with moisturizers and mild steroid creams. Paget disease affects one side, does not fully clear, and returns when creams stop. A nipple rash or sore that does not heal with simple skin treatment within a couple of weeks should be checked by a doctor.
How Doctors Confirm the Diagnosis
The doctor will examine the nipple and the whole breast and ask how long the changes have been there and what treatments you have tried. Because skin appearance alone cannot confirm the diagnosis, a small skin biopsy is usually taken from the nipple area to look for Paget cells under a microscope.
Imaging, usually a mammogram and often an ultrasound, looks for cancer inside the breast, and sometimes breast MRI is used as well. These steps together show whether there is cancer in the breast and where it is, which guides treatment planning.
Treatment in General Terms
Treatment focuses on the cancer inside the breast as well as the nipple itself. Surgery usually removes the affected tissue, which can mean removing the nipple and areola along with the cancer beneath, or mastectomy in some cases, depending on how much of the breast is involved.
Radiation, chemotherapy, hormone therapy, or targeted therapy may also be part of the plan, based on the type and stage of the cancer found. Your team will explain the reasoning behind each part, and outcomes are often good when the condition is found and treated at an early stage.
Frequently Asked Questions
Is Paget disease of the breast always cancer?
Paget disease is itself a sign that cancer cells are present in the skin of the nipple, and in most cases there is also cancer inside the breast. That is why it is always investigated fully, even though the skin change can look like a simple rash.
How long should I try eczema cream before seeing a doctor?
If a nipple rash does not clearly improve within about two weeks of simple skin treatment, or it keeps returning, see a doctor rather than continuing creams on your own. One sided nipple changes that persist always deserve an in person examination and, if needed, a biopsy.
Can the biopsy itself be painful or leave a mark?
A skin biopsy of the nipple area is a small procedure, usually done with local anesthetic, so it should not be very painful. It may leave a small mark, but it gives the clear answer that appearance alone cannot, and that answer guides all the care that follows.
A Note on Medical Information
The information on this website is for general educational purposes only and is not medical advice. It does not replace the advice, diagnosis, or treatment of a qualified healthcare professional. If you notice a change in your breast or have concerns about your health, please contact a healthcare professional promptly.