Differential Diagnosis for Pruritis on Breast and Nipple

Single Most Likely Diagnosis

• Eczema/Dermatitis: This is often the most common cause of pruritis on the breast and nipple, due to its prevalence and the fact that the breast area can be prone to irritation and allergic reactions.

Other Likely Diagnoses

• Psoriasis: Can cause pruritis and may involve the breast and nipple area, though it's less common than eczema.
• Pityriasis Rosea: Though it typically starts on the trunk, it can spread to other areas including the breasts, causing pruritis.
• Contact Dermatitis: Allergic reactions to soaps, detergents, or other substances can cause pruritis in the breast and nipple area.
• Atopic Dermatitis: Individuals with atopic dermatitis are more prone to skin irritation and pruritis, which can include the breast area.

Do Not Miss Diagnoses

• Paget's Disease of the Breast: A rare form of breast cancer that can present with eczema-like changes and pruritis of the nipple and areola. It's crucial to not miss this diagnosis due to its severe implications.
• Inflammatory Breast Cancer: Though rare, it can cause rapid onset of breast changes, including pruritis, and is a medical emergency.

Rare Diagnoses

• Neurological Causes: Certain neurological conditions can cause pruritis without a rash, including neuropathic pruritus, which is a rare condition.
• Systemic Diseases: Conditions like liver disease, kidney disease, or thyroid disorders can cause generalized pruritis, including in the breast and nipple area, though these would typically be accompanied by other systemic symptoms.
• Infestations: Though rare, infestations like scabies or lice can cause pruritis in any area of the body, including the breasts.