A woman with a painful, scaly nipple

Case presentation  A 58-year-old woman presents with an 18-month history of a scaly eruption on her right nipple. It is tender and mildly pruritic. The lesion has been unresponsive to treatment with a combination ointment containing triamcinolone acetonide, nystatin, neomycin sulfate and gramicidin. The patient’s last mammogram and breast ultrasound, performed 12 months earlier, did not reveal any breast masses. She has a history of Hashimoto’s thyroiditis but is otherwise in good health. She has no history of atopy. Her father has had prostate cancer.

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