HNY Central Digital Repository - York

• Distortion / retraction of nipple
• Nipple rash

• Recent change in nipple
• NON itchy rash or persistence of itchy rash after treatment

1. Nipple inversion can be a normal finding in some people. If it has been present for a long time the patient does not need referral. Patients only require referral if the nipple retraction is new and persistent, or associated with other symptoms
2. A non-itchy rash more likely to be pathological and may represent Paget’s Disease
3. Persistent itchy rash around the nipple is often a simple rash that happens to be on the breast rather than related to an underlying breast cancer. Consider the causes. DermnetNZ has good information on nipple eczema and differential. Nipple eczema | DermNet NZ
4. Treat any infection or eczema present
5. If rash persists then refer to Breast clinic
6. If rash is clearly part of a more widespread skin condition, then refer to dermatology

None

If any red flags – needs 2WW referral

Patient information leaflets/ PDAs

Paget's disease of the nipple - NHS (www.nhs.uk)

Eczema of the Nipple (breastcancer.org)

References

Nipple retraction and rashes (kernowccg.nhs.uk) reviewed Dec 2019

NICE guidance 12 Suspected Cancer Recognition and Referral reviewed Jan 2021

Responsible Consultant: Miss Jenny Piper

Responsible GP: Dr Ruth Guest