Beyond the Pearls: Cases for Med School, Residency and Beyond
Jun 11, 2026 · 12 min · 11 segments
Today's Case A 70-year-old healthy female was referred to the dermatology clinic for a crusted erythematous thin plaque on her left nipple. It has been present for 1 year and is associated with…
Jared FeldmanHost
Our case begins with a 70-year-old healthy female who's been referred to dermatology clinic for a crusted erythematous thin plaque on her left nipple.
It's been present for about a year and is associated with intermittent pruritus.
She's seen her primary care physician for this and was prescribed a topical antifungal cream and powder.
What additional information do we need to know from this patient? A detailed history should also include any additional symptoms like pain, nipple discharge, bleeding, or burning sensation, and it's critical to ask the patient whether any medications, both topical or oral, completely resolved the rash before.
Furthermore, the history should inquire about a patient's personal or family history of breast cancer.
When it comes to a physical exam for this patient, an examination of both breasts should be performed, including palpation for possible masses, as it's important to note that if there's any nipple retraction, this could be suspicious for malignancy.
Our patient's physical exam was unremarkable, thankfully, except for an eczematous thin plaque, no breast mass, or axillary lymphadenopathy was noted.
What's the differential for unilateral nipple rash or lesion? The differential diagnosis includes both benign causes such as eczema, contact dermatitis, tinea corpus, papillary adenoma of the breast, as well as malignant etiologies that are more concerning such as squamous cell carcinoma, basal cell carcinoma, malignant melanoma, and Paget's disease of the breast.
What's appropriate management at this time? Now, because this rash failed to improve on topical antifungal cream, it's reasonable to try a brief course of medium to high potency topical steroids if eczema or contact dermatitis is suspected.
However, a close follow-up is needed to ensure resolution of this cutaneous abnormality.
At follow-up, if the rash persists, a skin punch biopsy or full thickness wedge biopsy of the nipple is indicated.
A more detailed history of the patient revealed that she has also tried a medium-strength topical steroid ointment for several months, which did not improve the rash.
Our case begins with a 70-year-old healthy female who's been referred to dermatology clinic for a crusted erythematous thin plaque on her left nipple.
It's been present for about a year and is associated with intermittent pruritus.
She's seen her primary care physician for this and was prescribed a topical antifungal cream and powder.
What additional information do we need to know from this patient? A detailed history should also include any additional symptoms like pain, nipple discharge, bleeding, or burning sensation, and it's critical to ask the patient whether any medications, both topical or oral, completely resolved the rash before.
Furthermore, the history should inquire about a patient's personal or family history of breast cancer.
When it comes to a physical exam for this patient, an examination of both breasts should be performed, including palpation for possible masses, as it's important to note that if there's any nipple retraction, this could be suspicious for malignancy.
Our patient's physical exam was unremarkable, thankfully, except for an eczematous thin plaque, no breast mass, or axillary lymphadenopathy was noted.
What's the differential for unilateral nipple rash or lesion? The differential diagnosis includes both benign causes such as eczema, contact dermatitis, tinea corpus, papillary adenoma of the breast, as well as malignant etiologies that are more concerning such as squamous cell carcinoma, basal cell carcinoma, malignant melanoma, and Paget's disease of the breast.
What's appropriate management at this time? Now, because this rash failed to improve on topical antifungal cream, it's reasonable to try a brief course of medium to high potency topical steroids if eczema or contact dermatitis is suspected.
However, a close follow-up is needed to ensure resolution of this cutaneous abnormality.
At follow-up, if the rash persists, a skin punch biopsy or full thickness wedge biopsy of the nipple is indicated.
A more detailed history of the patient revealed that she has also tried a medium-strength topical steroid ointment for several months, which did not improve the rash.
The rest of this transcript — segmented and speaker-labeled, so you land on the exact moment something was said
Search every transcript — by keyword, by phrase, or by meaning, across every show Radar indexes
Trends — what is surging across podcasts, measured against its own baseline
Alerts — when a name you follow appears in a newly indexed episode
No account is needed to search Radar.