Why does paget disease of the breast cause breast skin changes?

Paget disease involves abnormal cells in the skin of the nipple and areola and may be associated with an underlying breast cancer. The affected surface can become red, scaly, crusted, itchy, sore, or thickened. The nipple may flatten or turn inward, and the changed area can resemble eczema. Because the process starts in or near the nipple, ordinary skin care may not make it settle.

Breast skin changes have many possible explanations, including dermatitis, infection, injury, or other breast conditions. The appearance alone cannot determine the cause. A clinician may examine the nipple, areola, and the rest of the breast, then arrange imaging or a skin sample when needed.

Book a clinical assessment for a new nipple or areola change that persists, returns, or affects one breast. Note when it began, whether it is itchy or painful, and whether there is a lump, nipple inversion, or discharge. Avoid repeatedly scratching, scrubbing, or applying steroid or antibiotic creams without advice, since these can alter the skin and delay recognition of the underlying pattern.

During assessment, ask what tests are appropriate and when results will be available. A photograph kept for your own comparison can help describe change over time, but it should not replace an examination.

Arrange prompt review for persistent one-sided scaling, crusting, redness, thickening, ulceration, nipple inversion, a new lump, or associated discharge. Seek urgent care for rapidly increasing swelling, severe pain, fever, spreading redness, or feeling acutely unwell, which can point to infection or another problem needing immediate treatment.

Ask whether the change looks more like dermatitis, infection, Paget disease, or another breast condition; whether imaging or a biopsy is needed; and how to care for the skin while waiting. Ask which changes should prompt urgent reassessment.