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
• Ulceration
• 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