Eczema and Paget's disease: Comparisons and contrasts
In the realm of breast health, two conditions can present with similar symptoms but require distinct approaches in diagnosis, treatment, and management. These conditions are Paget disease of the breast and eczema.
Symptoms
Paget disease typically affects only one nipple and the areola and presents as a scaly, inflamed, crusted, and thickened plaque-like lesion, often with very dry skin, pain, or itching. Additional signs can include nipple inversion or deformation, yellowish discharge or blood from the nipple, and sometimes a palpable breast mass in about 50% of cases.
On the other hand, eczema is a common, noncancerous skin condition that can appear on the nipple and areola but usually affects skin more diffusely and can be on both sides. It causes dry, itchy, red, and inflamed skin, but it does not cause nipple deformation, discharge, or breast masses.
Treatment
The treatment for Paget disease requires a multi-faceted approach, directed at the underlying breast cancer. Common treatments include surgery, such as mastectomy or breast-conserving surgery, possibly followed by radiation or systemic therapies, depending on the disease extent.
Eczema, however, is managed with topical treatments such as corticosteroid creams, moisturizers, and avoidance of irritants or allergens to control inflammation and itching. It is generally self-limited and not life-threatening.
Diagnosis
The diagnosis of Paget disease relies on clinical examination, noting persistent lesions affecting a single nipple area, nipple changes, and associated masses, followed by a biopsy of the nipple skin to confirm the presence of malignant Paget cells. Imaging (mammogram, ultrasound) is needed to detect any underlying breast cancer.
Eczema is diagnosed based on typical appearance, bilateral involvement, absence of nipple distortion or discharge, and response to topical treatments. Biopsy is rarely required unless the lesion does not improve or other diagnoses are suspected.
In summary, Paget disease presents as a unilateral, scaly, crusted nipple lesion possibly with nipple changes and underlying cancer, requiring cancer-directed treatment and biopsy for diagnosis. Eczema is a common, bilateral, benign skin inflammation without nipple distortion or discharge, treated effectively with topical anti-inflammatory creams. Persistent nipple changes or unilateral rashes unresponsive to eczema treatment should prompt evaluation for Paget disease.
Further testing may be required to diagnose Paget disease, including a skin biopsy, breast biopsy, or medical imaging such as mammography, ultrasound, or MRI. Treatment for eczema focuses on controlling symptoms, with approaches varying depending on the cause.
It is crucial to remember that self-diagnosis should be avoided when it comes to breast health. If you notice any persistent changes or unusual symptoms, it is always best to consult a healthcare professional for a proper evaluation.
[1] Mayo Clinic. (2021). Paget disease of the breast. [online] Available at: https://www.mayoclinic.org/diseases-conditions/paget-disease-of-the-breast/diagnosis-treatment/drc-20371174
[2] American Academy of Dermatology. (2021). Eczema. [online] Available at: https://www.aad.org/public/diseases/eczema/overview
[3] National Eczema Association. (2021). Paget Disease of the Breast vs. Eczema. [online] Available at: https://nationaleczema.org/eczema/paget-disease-of-the-breast-vs-eczema/
[4] National Cancer Institute. (2021). Paget Disease of the Breast. [online] Available at: https://www.cancer.gov/types/breast/hp/paget-disease-treatment-pdq
[5] American Cancer Society. (2021). Paget Disease of the Breast. [online] Available at: https://www.cancer.org/cancer/breast-cancer/understanding/basic-information/paget-disease.html
- Paget disease, a breast entity, can present as a unilateral, scaly, crusted nipple lesion that requires a biopsy for diagnosis, while eczema, a common skin-care condition, manifests as a benign, bilateral, inflammation of the skin.
- Treatment for Paget disease involving breast cancer involves multi-faceted approaches such as surgery, radiation, and systemic therapies, compared to eczema, which is managed with topical treatments like corticosteroid creams and moisturizers.
- Symptoms of Paget disease include a scaly, inflamed, crusted, and thickened plaque-like lesion on the nipple and areola, possibly with nipple inversion, deformation, discharge, or breast mass, distinct from eczema, which doesn't cause nipple changes or breast masses.
- Diagnosis of Paget disease requires clinical examination, biopsy, and imaging like mammogram, ultrasound, or MRI, whereas eczema is diagnosed based on typical appearance, bilateral involvement, and response to topical treatments.
- In health-and-wellness, it is essential to remember that self-diagnosis should be avoided, especially for breast conditions like Paget disease, and consulting a healthcare professional for a proper evaluation is always the best course of action.
