Breaking Down Zuska's Disease: Does It Impact Both Men and Women?

Zuska’s Disease, also known as squamous metaplasia of the lactiferous gland, is a chronic and rare health condition. It is characterized by a subareolar breast abscess (SBA) of the nipple of one or both breasts, leading to a peri-areolar fistula. The pathophysiology includes squamous metaplasia of the lactiferous glands, leading to keratin deposition and blocking the opening of the lactiferous duct. Smoking is considered a risk factor that can lead to squamous metaplasia. Our comprehensive case study shows that household smoke is also a risk factor for the development of Zuska’s Disease. It primarily affects females, but in rare conditions, it can affect men as well.

Case Presentation:

A 26-year-old female, who never smoked but has a history of exposure to household smoke, presented with pain and swelling in the subareolar region of the right breast for the past 20 days. She sought treatment from nearby hospitals but did not improve clinically.

Past Medical History:

She reported a similar episode of a subareolar abscess 6 years ago and received treatment from various medical institutes, finally being treated at our institution.

Examination and Findings:

She was conscious, alert, and afebrile at the time of examination. Her vitals were stable. There was a fistulous opening at the 6 o'clock position of the subareolar region with pus discharge. Nipple inversion was noticed, and there was local tenderness.

Diagnostic Work-up:

First, a pus sample was collected for culture and sensitivity, which showed bacterial growth after 24 hours of incubation. The organism Escherichia coli was found to be sensitive to Amoxicillin + Clavulanate. A mammogram was done for differential diagnosis, which showed asymmetric density and minor nipple inversion.

Figure 1. Showing Nipple inversion Red Arrow, Peri-areolar fistula black arrow.

Figure 2. Mammogram of same patient.

Zuska's Disease Pus Culture and sensitivity.pdf

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Management: The patient was planned to be managed conservatively with antibiotics for 5 days after pus culture and sensitivity, along with daily dressing of the fistula tract with Jatyadi Tailum. To prevent further blocking of the lactiferous gland with keratin deposits, the patient was advised to perform daily breast massage from the peri-areolar region towards the nipple to prevent further reinfection. The patient's wound healed completely within 1 month of initiating treatment. However, there are chances of reinfection with conservative methods. To prevent this, the patient was advised to continue breast massage. Surgical excision of the fistula tract and infected lactiferous gland is the treatment of choice for patients with recurrent episodes of infection, but the chances of cosmetic disfigurement are higher with surgical excision.

Figure 3 showing healed peri-areolar fistula tract.

Conclusion: Conservative management of Zuska's disease appears to be better than surgical excision of the tract, as it has fewer complications. Both conservative management and surgical excision have chances of recurrence. Breast massage is the best way to reduce the chances of recurrence.