It’s common for women with Paget disease of the breast to receive a diagnosis of eczema, which can delay diagnosis and treatment for breast cancer.
The look-alike symptoms of Paget disease and eczema of the breast make it hard to distinguish one from another. But there are ways to correctly diagnose and treat these very different conditions.
Paget disease of the breast is a rare type of breast cancer, representing only 0.5 to 5% of breast cancers. Other names are Paget disease of the nipple and mammary Paget disease.
Eczema is an inflammatory condition that can affect skin anywhere on the body, including the breasts. Eczema affects more than 31 million people in the United States. It’s also known as atopic dermatitis.
This article covers the difference between Paget disease and eczema of the breast, plus what you need to know about symptoms, treatment, and outlook for people with these conditions.
In this article, we talk about the difference between Paget disease of the breast and eczema in people assigned female at birth.
It’s important to note that not everyone assigned female at birth identifies with the label “female.” However, at times we use “male” or “female” to reflect the language in a study or statistic or to make sure people can find this article with the terms they search.
When possible, we aim to be inclusive and create content that reflects the diversity of our readers.
Paget disease of the breast starts in the nipple and then spreads to the areola and breast skin. About half of people with Paget disease of the breast have a lump behind the nipple.
Symptoms of Paget disease are described below:
|Initial symptoms||Advanced symptoms|
|red, scaly rash on the nipple and areola||flattened or retracted nipple|
|small bumps on the nipple and sometimes the areola||ulcerated nipple|
|sore, inflamed skin||bleeding from the nipple|
|tingling or burning sensation|
Breast eczema is an inflammatory skin condition that can affect any part of the breast. Symptoms come and go and may include:
Paget disease of the breast and eczema both cause discoloration, rash, and itchiness.
One difference between Paget disease and eczema is that Paget disease typically affects only one breast and eczema is more likely to affect both. Another is that Paget disease always affects the nipple, while eczema may not.
This gallery provides pictures of both conditions.
It’s not clear what causes Paget disease of the breast. Researchers have two main theories. One is that distinctive Paget cells break off from a mass within the breast and then travel through milk ducts to the nipple. Another is that it’s a distinct, spontaneous process that starts in the outer layer of skin at the nipple.
Contributing factors may include:
- genetic abnormalities
- exposure to ultraviolet rays, certain chemicals, or radiation
- diet and stress
The mean age at diagnosis is
- mutations to BRCA1, BRCA2, and other genes associated with breast cancer
- high dose radiation exposure
Other risk factors may include:
- previous diagnosis of breast cancer
- having a first degree relative with breast cancer
- history of noncancerous (benign) conditions such as breast atypia (changes in breast cells) or lobular carcinoma in situ
- overweight and obesity
Eczema happens when your immune system reacts to an irritant. Anyone can get eczema, but it usually starts in childhood. Some potential triggers for breast eczema are:
- soaps and body washes
- powders and lotions
- laundry detergent and fabric softeners
- fabrics such as wool or polyester
- pooling of sweat around the breasts
Diagnosis is likely to start with a clinical exam and review of your medical history. Some things a doctor or healthcare professional may want to discuss are:
- specific symptoms, how long you’ve had them, and if this has happened before
- whether you have a rash anywhere else on your body
- what treatments you’ve tried, if any
- whether you’ve previously received an eczema diagnosis
- personal and family history of breast cancer
This may be enough to reach the diagnosis of eczema. However, it’s
If there’s any question about the diagnosis, further testing may include:
- Skin biopsy: A skin biopsy is the removal of a tiny piece of skin for examination under a microscope.
- Imaging tests: Mammography, breast ultrasound, or breast MRI may reveal a suspicious mass.
- Breast biopsy: A breast biopsy is the removal of a piece of suspicious tissue for examination under a microscope. A biopsy is the only way to confirm or rule out a diagnosis of breast cancer.
Rarely, Paget disease of the breast involves just the skin. But about 90% of cases involve ductal carcinoma in situ (DCIS) or invasive breast cancer.
The main treatment is surgery, including:
Other treatment may include:
Depending on the extent and severity of eczema, treatment may include:
- moisturizing creams
- over-the-counter or prescription topical medications, including corticosteroids
- light therapy
- injectable biologics
Other ways to manage disease flare-ups are:
- identifying and avoiding triggers
- moisturizing your skin after bathing or showering
- using medications consistently and as prescribed
Some factors that can affect outlook for people with Paget disease of the breast are:
- whether there’s a tumor under the nipple or elsewhere in the breast
- whether tumors are noninvasive or invasive
- whether cancer has reached the lymph nodes
- tumor grade
- hormone receptor and HER2 status
DCIS is an early form of breast cancer that hasn’t spread outside the breast ducts. With treatment, the outlook is good. Without treatment, DCIS can become invasive. The survival rate may be
There’s no cure for eczema, but you can manage it with treatment. Identifying and avoiding triggers can lead to fewer flare-ups.
Paget disease of the breast is a rare type of breast cancer. Eczema is an inflammatory skin condition. Symptoms are so similar that it’s hard to tell them apart without diagnostic testing.
They both cause discoloration, rash, and itchiness. One difference between Paget disease and eczema is that Paget typically affects only one breast and eczema is more likely to affect both. Another is that Paget always affects the nipple, while eczema may not.
It’s not unusual for someone with Paget disease to start out with a diagnosis of eczema, which can delay treatment for breast cancer. That’s why it’s important to see a doctor for a rash that involves the nipple or won’t clear up.
It’s possible to manage eczema by avoiding triggers and using medications as prescribed. Treatment for Paget disease is the same as for other types of breast cancer. And as with other types of breast cancer, it’s easier to treat in earlier stages.