long lasting red patches on breasts

[tlb007]

Hello,  Several months ago I noticed a red, non-itchy, non-scaly, flat spot about 0.75 cm diameter on my areola.  The next day there were similar, smaller patches on both areola.  The larger patches had flesh-colored centers, but the smaller ones were just red.  The spots ONLY occurred on the areolas; nowhere else.  They didn't appear to grow or shrink; they just appeared. I saw my gyno, as I was concerned about Paget's. She said it was not Paget's and prescribed a steroid cream (Clobetasol) for two weeks.  This appeared to make the rash worse, and the entire area became red.  So she said it must be fungal, and prescribed Clotrimazole for two weeks.  The general redness went away, but the red patches remained.  The red patches changed color slightly using the Clotrimazole, but after two weeks they had not improved, so gyno sent me to a dermatologist.  The patches no longer had the same distinct look as they started with before using all these creams, but after looking at the red skin for about 5 seconds, the dermatologist said it must be dermatitis and that the clobetasol was just too strong.  She prescribed another steroid (Locoid) + emollient barrier cream 2x day.  After ~4 weeks the patches finally started to fade, I reduced treatment to 1x/day for two more weeks.  The patches no longer had distinct edges, but some redness (looking like tiny veins) remained (this entire process took place over ~4 months).   The dermatologist said it may take a while to completely return to normal color, and told me to continue the emollient barrier cream 2x/day.  That was ~3 months ago.  About 6 weeks ago, the patches returned!  They look exactly the same as the last time (non-itchy, non-raised, non-scaly), but in places not affected the first time (still confined only to areolas).  I've been using the Locoid + cream, but they do not seem to be improving, nor are they getting worse.  They do, however, appear more noticeable after a hot/warm shower.

I hadn't changed anything in the last six months (diet, soap, detergent, vitamins, etc.), and had been using the emollient/barrier cream religiously. I am concerned that this is more than dermatitis, but don't know what else it could be, or if I should be concerned about this?!  Is it possible that it could be Paget's (I am 36 yrs. old)? I am also wondering now if the steroid didn't actually resolve the first bout, but that it just happened to finally fade after ~4 months on it's own.  Any ideas?  This is really starting to concern me!

[tlb007]

Thank you for your reply.  I made an appointment to see my dermatologist again (can't get in till the end of the month) and will insist on further testing of these patches!

[Bhupinder Kaur, MD]

Hello,
Since the symptoms have been persisting for such a long time, hence it may be more than dermatitis and it makes sense to get Paget’s disease of the nipple ruled out. It very closely resembles eczema and dermatitis and hence needs to be ruled out. Recommended tests are a mammogram and a biopsy to confirm the diagnosis, and cytopathology may also be helpful.
I hope it helps. Take care and regards.