Dear doctor;

A few weeks ago I had a really itchy nipple with a sort of a rash – the skin on a small area of the nipple was flaky. It cleared up. A couple of weeks later, it’s come back. I have no discharge or other pain and regularly check my breasts for any changes. Is this itching anything to worry about?

Brenda, 22, Gikondo

Dear Brenda,

Itchy nipple along with crusting can be due to eczematous dermatitis. This can occur due to allergy to something used or something present in the environment like  pollens, spores, dust, among others. Dryness of the nipple and surrounding area, use of hot water for washing can precipitate and aggravate the redness and itching. Repeat exposure to the allergy producing substance can cause repetition of the symptoms.

Use of local antiallergy ointments or a short course of anti allergy tablets can cure this condition. Sometimes fungal infections can also cause itching, crusting and redness around nipples.  Scratching to soothe itching due to any of these conditions can cause secondary infection. This would manifest as swelling, redness and pain. 

Paget’s disease of the breast is a malignant condition of the milk duct or nipple which causes redness and itching similar to atopic dermatitis or eczema. This usually occurs in middle-aged women of 50 years or more but can occur in younger or older women. Paget’s disease is diagnosed by mammography and biopsy.

The treatment is by surgery and or chemotherapy, depending on stage of the cancer. My advise is that you consult a dermatologist to ascertain the underlying cause of itching and rash, so that it can be treated completely.