Differential Diagnosis for Nipple Sensitivity in a 75-year-old

Single Most Likely Diagnosis

• Hormonal Changes: At 75 years old, hormonal fluctuations, especially in postmenopausal women, can lead to nipple sensitivity due to the decrease in estrogen levels. This is a common and benign condition.

Other Likely Diagnoses

• Ductal Ectasia: A condition where the milk ducts in the breast become widened, leading to symptoms like nipple sensitivity, discharge, or inversion. It's more common in older women.
• Mastitis or Breast Infection: Although less common in older women without a history of recent breastfeeding, mastitis can occur and cause nipple sensitivity, pain, and swelling.
• Thyroid Disorders: Hypothyroidism or hyperthyroidism can cause changes in breast tissue, leading to nipple sensitivity among other symptoms.

Do Not Miss Diagnoses

• Breast Cancer: While less likely, breast cancer must be considered, especially if there's a new lump, change in nipple appearance, or discharge. Nipple sensitivity can be an early symptom in some cases.
• Paget's Disease of the Breast: A rare form of breast cancer that starts on the nipple and extends to the areola, causing eczema-like changes and sensitivity.

Rare Diagnoses

• Neurological Conditions: Certain neurological disorders, such as neuropathy or multiple sclerosis, can cause abnormal sensations, including sensitivity in the nipples.
• Sarcoidosis: A condition that can cause inflammation in various parts of the body, including the breasts, leading to nipple sensitivity among other symptoms.
• Inflammatory Breast Cancer: A rare and aggressive form of breast cancer that can cause the breast to look inflamed and feel warm or sensitive, including the nipple area.