Nipple retraction and rashes
There are many women whose nipples have always been pulled in, in others pulling in of the nipple happens from time to time and lasts for a few minutes only.
Patients only require referral if the nipple retraction is new and persistent, or associated with other symptoms, such as an underlying lump, or blood-stained discharge.
Rash or eczema of the nipple
Persistent itchy rash around the nipple – areolar complexis usually a simple rash that happens to be on the breast rather than related to an underlying breast cancer.
Non-itchy rash - referral advised whether involving nipple or not
Additional symptoms indicating the need for immediate referral include:
- Associated lump
- Skin distortion
- Unilateral nipple discharge
If these are absent, initial Primary Care management includes:
- Regular application of topical steroid for at least 2 weeks and review response. The topical steroid should be placed under an adhesive dressing to be effective, and applied twice a day for 2 weeks.
- Treat any apparent associated infection with Flucloxacillin or Clarithromycin
- Refer if not resolved within 2 weeks of good compliance with treatment.
- One of the conditions to be ruled out in this case is Paget’s Disease, however please note, this always affects the nipple and not just the areola.
- If condition is clearly part of a more generalised skin rash without other breast symptoms, dermatology referral may be worth considering in the first instance.
Date Reviewed November 2021
Next Review Date November 2022
Author Dr I Boyd, RMS GP Sifter
Reviewed By Dr M Attridge, RMS GP Sifter
Contributor Dr Rebecca Osborne, GPwSI Breast, RCHT
Version No. 1.0