Differential Diagnosis for Right Nipple Pain in a 78-Year-Old Man

Single Most Likely Diagnosis

• Dermatitis/Eczema: This is a common condition that can cause nipple pain and is often seen in older adults. It can be due to various factors such as irritation from clothing, soaps, or other substances.

Other Likely Diagnoses

• Gynecomastia: Although more common in younger men, gynecomastia (enlargement of breast tissue) can occur in older men due to hormonal changes and can cause nipple pain.
• Breast Cyst or Abscess: These are fluid-filled sacs or pockets of infection that can develop in the breast tissue and cause pain, especially if they become infected.
• Nipple Piercing or Trauma: If the patient has a history of nipple piercing or recent trauma to the area, this could be a cause of nipple pain.
• Inflammatory Breast Conditions: Conditions like periductal mastitis can cause nipple pain and are more common in men.

Do Not Miss Diagnoses

• Breast Cancer: Although rare in men, breast cancer must be considered, especially if there's a lump, nipple discharge, or skin changes. Delayed diagnosis can be fatal.
• 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 pain.
• Infection (Cellulitis, Abscess): Severe infections can lead to sepsis, especially in older adults, and require prompt antibiotic treatment.

Rare Diagnoses

• Sarcoidosis: A condition that can cause lumps or inflammation in various parts of the body, including the breast, leading to nipple pain.
• Neurological Causes (e.g., Neuroma): Rarely, nerve damage or growths can cause nipple pain.
• Endocrine Disorders: Certain hormonal imbalances, such as those caused by pituitary or thyroid disorders, can lead to gynecomastia or other breast changes that might cause nipple pain.