Intended for healthcare professionals

Endgames Case Review

Unilateral nipple rash in a man

BMJ 2021; 373 doi: (Published 15 April 2021) Cite this as: BMJ 2021;373:n750
  1. Hamid Abudhaise, specialist registrar1,
  2. Mohsin Dani, consultant2,
  3. Haresh Devalia, consultant2
  1. 1UCL Division of Surgery and Interventional Sciences, Royal Free Hospital, London, UK
  2. 2Department of General Surgery, Maidstone and Tunbridge Wells NHS Trust, UK
  1. Correspondence to: H Abudhaise hamid.abudhaise.11{at}

A man in his 50s was referred to the breast surgery clinic with a one month history of an exudating, oedematous, itchy right nipple-areolar complex. He had experienced hay fever in the past but reported no recent contact with known irritants or allergens. He had not used topical steroids before presentation. On examination, both the right nipple and the areola were erythematous, thickened, and excoriated (fig 1). The left nipple was unaffected, and there were no palpable breast lumps or axillary lymphadenopathy bilaterally. Lesions were not present elsewhere. Mammography and ultrasonography only showed thickened right areolar skin. Right areolar punch biopsy revealed epidermal hyperplasia, hyperkeratosis/parakeratosis, and spongiosis with subepithelial inflammation.

Fig 1

Right nipple eczema, showing erythema, oedema, and excoriation of …

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