Zuska's disease

Cutaneous signs and symptoms in subareolar abscesses of the breast or lactiferous fistula (Zuska's disease, ZD) are common and frequent, but generally dermatologist ignore this clinical entity. An epithelial squamous metaplasia causes plugging and obstruction of the ducts is a pathogenetic event. Subsequent inflammatory reaction and infection produce local and general symptoms. Nipple retraction, recurrent episodes of erysipela and presence of painful nodules under the areola in a non-lactating woman are suspect. The presence of a milky draining sinus in the areola is characteristic. The diagnostic challenge is to differentiate these benign condition from a breast cancer. Treatment with antibiotics in the acute and chronic phase is mandatory, surgical removal of abscess and duct is sometimes resolutive. The authors describe a case of ZD in a pathologically obese woman treated with a long term penicillin schedule with no favorable effects.