By Marshalee George, Kimlin Tam Ashing

Normally the skin on the breasts is a similar color to the skin on the rest of the body, though it may be lighter due to less sun exposure. The nipple and areola (the dark area around the nipple) are usually a darker color with some bumps and textures. Just like the rest of the skin, there may be freckles or moles on the breasts. Some people also have stretch marks on their breasts due to changes in size over time.

Rash on the breasts

You may develop a rash on the breast and be concerned because you wonder if it is inflammatory breast cancer. The best thing to do when you develop a rash is to talk to your doctor about it. Rashes can often be due to sweating and rubbing of skin surfaces together (also called chafing), and this most commonly occurs on the underside of the breast.

Another common cause of skin rash is exposure to new fabrics or products. Let your doctor know if you have a new bra, new skin cream, or new laundry detergent. If you can’t determine the cause of a rash, the doctor may prescribe a topical steroid ointment or antifungal or antibacterial cream. The majority of skin rashes are not due to breast cancer.

If the rash persists after treatment by your doctor, then you need to have further evaluation by a skin or breast specialist to determine if it is another breast condition or breast cancer.

Paget’s disease

Paget’s disease may appear as a rash around the nipple, especially on the areola. It’s often mistaken for eczema or dermatitis. In addition to the rash, Paget’s disease may involve the following:

  • Itching, tingling sensation or redness of the nipple and/or the areola
  • Inverted or flattened nipple
  • Nipple discharge that may be bloody or yellowish in color
  • Dry, scaly, flaking, crusty, or thickened skin around the areola

Many times the symptoms of Paget’s disease are mistaken for those of another skin condition. It’s often misdiagnosed, leading to delays in treatment. Many patients with Paget’s disease often have breast cancer deeper in the breast, usually DCIS or invasive ductal carcinoma, which is why it’s important to see your healthcare provider about persistent rashes on the breast. Treatment for Paget’s disease is similar to breast cancer and may include breast-conserving surgery (lumpectomy) and radiation therapy.

If a rash on the breast is related to breast cancer, it will never go away — it either stays the same or gets worse after topical medication treatment.

Skin thickening on the breast

In skin thickening of the breast, the skin may appear to be swollen or filled with fluid and may have a ridging pattern resembling the texture of an orange peel (sometimes called peau d’orange, meaning “orange-peel skin”).

Although skin thickening is one of the signs of inflammatory breast cancer, for it to indicate cancer there are typically other signs that most often occur together to confirm the diagnosis:

  • Redness over the breast
  • Breast feeling warm
  • Breast becoming harder

If you experience any skin thickening on the breast, contact your doctor to have those symptoms evaluated.

Cellulitis on your breasts

The breast may become red if there is a skin infection (called cellulitis). Cellulitis can often occur after radiation therapy or breast reduction surgery because these treatments can cause inflammation in the skin. Any inflammation of the skin can increase the risk of secondary infection.

When the cellulitis is due to infection, it’s caused by bacteria that have gotten into the skin through a broken barrier, such as a wound. The infection can spread quickly, producing inflammation in the layers (dermis and subcutaneous tissue) of the skin. As the white blood cells in the immune system fight the infection, increased blood flow is seen at the site in the form of redness.

You may experience pain, tenderness, and swelling at the breast site and may develop a swollen lump or enlarged lymph node under the arm. The lymph nodes tend to get large closest to the area where there is an infection. This is a sign that the body’s defense system (the immune system) is activated.

If you experience these symptoms, you must notify your doctor so you can be treated with an appropriate antibiotic.

Mastitis of the breast

Mastitis is similar to cellulitis in that the breast may become painful, red, and warm to the touch. However, mastitis is due to an infection deep in the skin, in the mammary gland (the milk-producing gland in the breast). It is due to bacteria getting into the breast via the nipple or a break in the skin. Mastitis most often occurs along with cellulitis of the breast skin. Other symptoms that may occur with mastitis include headache, fatigue, fever, and chills.

Breast abscess

A breast abscess is a hollow space in the breast that is filled with pus. This is due to infected milk ducts or an infection from the skin, which is caused by bacteria that get into the skin from the nipple or a break in the skin. Staphylococcus aureus is the most common bacteria found in breast abscess. Both cellulitis and mastitis (see the preceding two sections), if left untreated, can develop into a breast abscess.

Other factors that predispose a person to developing an abscess are diabetes and smoking. Smoking causes vasoconstriction and limits oxygen to the breast tissue for healing, thereby causing a delay in healing and risk of prolonged infection.

Most breast infections are treated with an antibiotic to kill Staphylococcus aureus, as this microbe is the most common cause. If the infection is due to a different bacteria, then the antibiotics may not help and the infection can get worse. If that happens and the infection gets worse a few days after starting antibiotics, your antibiotics need to be changed. Once an infection has an abscess, the abscess will need to be drained with a needle or surgically, in addition to taking antibiotics.

Breast infections are most common in women who are breastfeeding or who have recently stopped breastfeeding. Breast infection is caused by a break in the skin or the nipple that bacteria can get into. That means that a cut or scratch in the skin as well as a bite on the nipple can be the access point for the bacteria to get into the breast.

Breast infections do not cause or increase your risk of breast cancer.