Maybe it's nothing?

[omalley]

For a couple months, I've had an irritation on one nipple.  At its worst, it's scaly, cracked, raw, burning & itching with little shooting pains into the breast.  It clears up with coritsone cream (used 4-5 times a day for 1-2 weeks) but the rash comes back when I stop the cream.  

It's only on one nipple, and doesn't affect the areola, except just where it meets the nipple.  Also, my nipple looks slightly different, maybe I'm just imagining it, but it seems a little more swollen on one side. It feels like its being stimulated all the time and also, it seems a lighter/brighter color than the other nipple.  But maybe that's because of all the cream.    

It's probably just excema (I get it sometimes on other areas) or some kind of heat rash, but I'm concerned about Pagets.  BUT, I've heard that Pagets won't clear up with steroidal creams, and my nipple does clear. Right now, I've been off the cream 5 days and it's just a tiny bit dry and a little itchy. My doctor says wait until September and we'll do a biopsy if it doesn't clear.  But I'm wondering if I should wait that long since it's been going on a couple months already? I don't mean to be paranoid, but I'm worried.  Any feedback would be appreciated, especially regarding the fact that it clears & comes back.  Maybe I should be more patient?

[CCF-RN,MSN-rf]

Dear omalley:  The fact that it goes away, albeit temporarily, makes it less likely that this is pagets.  Waiting until September is probably perfectly safe.  However, if you are really nervous, you can get a biopsy.  One other thought, though.  If you are prone to eczema, have you changed any detergents, fabric softeners, lingere?  Sometimes these things can cause irritation.

[surgeon]

if it totally disappears for a time with cortisone it's pretty unlikely to be Paget's. But at some point if it keeps coming back, a biopsy is a good idea. How much time to give it isn't carved in stone, and depends in part on how nervous it's making you. Waiting til September isn't likely to be a problem no matter what's going on; but if it's driving you crazy, doing a biopsy is a pretty small thing.