Paget's Disease of the nipple- should i demand biopsy?

Roughly 6 months ago, my nipple started getting very itchy. It was itchy for about 1 month. Another month later it started scaling, dry flakey skin that continued to drop or peel off on it's own, there would be clear fluid around the nipple. I have not had any discharge from the actual nipple though. It started to get worse and redder. So i went to the doctor. She said it looked like dermatitus and prescribed advantan cream. I was to apply this cream a few times a day for 2 weeks. I did this and it only helped a little bit. So i went back and was told to use this cream for another 3 weeks. So i did this, and it looked like it had cleared up, but 2 days after i stoped using the cream it came back and now the red scabby nipple thing started to move futher outwards so its effecting the nipple and sourrounding part, but it started in the nipple first.

So back to the doctor again, and this time was precribed hydrozole cream. So i have used this for 3 weeks and it's not working, and still itchy and scaling. Doctor said to just keep using this cream, which i am and it's not clearing up. Only 1 nipple is effected, the doctor checked for lumps and i dont have any. I really want a referral to a dermatologist and have a biposy done but my doctor seems reluctant and says it will clear up eventually. It has been 6 months and it has not cleared up. Should be concerned this is now paget's disease of the nipple? I am 21yrs old, and i have read only women in their 50's and 60's can get this. I have no history of breast cancer in either sides of my family.

[CCF-RN,MSN-rf]

Dear flutter7:  Scaling and itching of the nipple can be due to many skin disorders, the most common causes being infection or allergic skin reactions.  Paget's disease of the breast is a
type of cancer that presents with itching, scaling or soreness in the nipple and areola.  It is most common in women in their 50's and 60's but can technically occur at any age.  However, given that the nipple and areola are "skin," different types of dermatitis (inflammation of the skin) are possible, and more common explanations. Nonetheless, since this scaling and itching has persisted for 6 months, it may be worth while seeing a dermatologist for evaluation.  

[flutter7]

Also forgot to add this. Sometimes the nipple will appear wider and flatter, sort of inverted, only sometimes, and it's now also a noticibly little bit bigger then my other nipple.

[surgeon]

It would be very unlikely -- but not impossible -- for a woman your age to have Paget's disease. I'd agree that a persisting unilateral (one side only) nipple rash needs a diagnosis, likely a biopsy. It's impossible to diagnose a rash online. It's possible it's one your doctor can tell confidently is ok. But it makes sense, from over here, to consider seeing either a dermatologist or breast surgeon. Odds are huge that it'll be fine.

[lizzysdelight]

A related discussion, paget's disease of the nipple was started.