Pagets? Eczema?

Hi all!

I’m looking for some advice regarding the symptoms and differences between pagets and eczema.

I am a 25 year old female with a history of sometimes quite severe eczema all over my body but it’s very controlled at this moment in time. The reason it is so well controlled at the moment is because around 4 weeks ago I had an awful experience with mastitis which stemmed from bacteria entering my breast via damage on my nipple (I am not pregnant nor have children). It was put down to eczema at the time and thus I was prescribed with very effective creams. The infection was severe and the doctor was very worried about my condition, she wanted to admit me to hospital but due to my stubbornness I managed to convince her to let me try the strong course of penicillin for 24 hours first. I improved and continued the penicillin for another 10 days. Thankfully the infection cleared up and the penicillin also helped to clear up a lot of the other eczema too.

Prior to this, for quite a few months I had noticed that my nipple was dry, flaking, itchy and discharging into my bra so much so I was often ‘peeling’ my bra off. The discharge is browny yellow in colour and i also often have red, weepy patches. Anyway I put it down to eczema and didn’t mention it. It was only ever the one nipple.

My nipples have always been quite flat, they’ve never really protruded as a ‘normal nipple’ would.

Since the infection cleared and the eczema around my body has also cleared, but the flaking, itchy surface and discharge continues. I have noticed it doesn’t smell very nice. I also have a bit of redness left around the areola, to look at, it looks like the Areola is very large which is fairly odd. I’ve also noticed that this one nipple and areola can ‘wrinkle’ up quite a lot, it looks like someone’s pinching the surrounding skin together. When this happens it all gets very hard and I can feel a solid mass right behind the nipple extending to just below the bottom of the areola. My other nipple doesn’t do this. I’ve noticed there are some weird looking ‘dimples’ at the very centre of the nipple - 3 I think.

It’s the only part of my body left with symptoms of eczema. I wasn’t worried about it, I’ve just continued to apply the cream in the hope it will improve over time.

I had a ‘follow up’ appointment with a different doctor yesterday, to check on my breast following the infection. He was very nice and was pleased that the infection has cleared up well, although he said somethings clearly not right, despite me having no more symptoms of mastitis. There was an element of concern and he gave me an examination, to which he concluded I need further treatment and monitoring.

He’s prescribed me with another course of antibiotics for 2 weeks to see if there is any improvement. He said if in 1 week the symptoms have not got any better at all then to go back and he would have to refer me to the breast clinic for some tests for cancer. Cancer?! This caught me completely off guard as I thought it was unheard of for girls of my age and certainly with the symptoms I have - I thought lumps were the sole indicator of breast issues. He explained that cancer is very rare in someone of my age but not impossible but told me not to worry. PFFT!

Obviously I’ve become a little panicked about the situation. I’ve found out that Paget’s disease presents itself as eczema but ive realised the symptoms seem to be parallel to what I’m experiencing.

I’m really confused and I feel like I want solid proof that this is eczema only. Am I too young for this? What happens at a breast clinic? Will symptoms get worse If it is pagets? What should I be looking for? Really appreciate any advice/previous experience with this!

Hi Salxo,

Try not to panic!  It is quite right that your GP considers referring you, as the breast  clinic is the best place to get to the bottom of it. The clinic is for all breast conditions, not just cancer, however, most women are referred under the 2 week rule if it’s not clear what a breast symptom is. 

You are right, bc in young women is very rare, but is is sensible to make sure you are properly examined.

For the vast majority of women, there turns out to be a benign reason for the breast change, not bc. 

As you say, it’s most likely related to your eczema, but it’s good to be absolutely sure. 

At the clinic, you will be examined by the dr & an ultrasound examination is usually done, a mammogram may also be done. If it’s not clear what it is, then a biopsy maybe taken for the area, in which case there is a further 1-2 weeks for the results, but hopefully it won’t come to that. If it’s clear what it is, you will be told on the day. 

Best wishes with it all

ann x