During a physical examination, the doctor examines the unusual areas of the breast, especially the appearance of the skin on and around the nipples and feeling for any lumps or areas of thickening.The most common test used to diagnose Pagets disease is the biopsy, removal of a tissue sample from the affected area which is then examined under the microscope by a pathologist, who distinguishes Paget cells from other cell types by staining tissues to identify specific cells (immunohistochemistry). CD138 and p53 can be used, both being positive in Pagets disease, and negative in Toker cells, which are normal epithelial cells with clear cytoplasm that can be difficult to distinguish from Pagets disease. Besides, Paget cells stain positive for CK7 in >90% of the cases. Similarly, GATA3 and HER-2 are expressed in around 90% of the cases, and can be used for the confirmation, including CK7 negative Paget disease.Samples of nipple discharge may also be examined under the microscope to determine whether Paget cells are present. Imprint or scrape cytopathology may be useful: scraping cells from the affected area, or pressing them onto a glass slide to be examined under the microscope.On average, a woman may experience signs and symptoms for six to eight months before a diagnosis is made. Treatment
Pagets disease of the breast is a type of cancer of the breast. Treatment usually involves a lumpectomy or mastectomy to surgically remove the tumour. Chemotherapy and/or radiotherapy may be necessary, but the specific treatment often depends on the characteristics of the underlying breast cancer.
Livedoid dermatitis is a iatrogenic cutaneous reaction that occurs immediately after a drug injection. It presents as an immediate, extreme pain around the injection site, with overlying skin rapidly becoming erythematous, violaceous, or blanched ("ischemic pallor"): 124  and sometimes with reticular pattern. The reaction eventually leads to variable degrees of necrosis to the skin and underlying tissue. The wound eventually heals, but can lead to atrophic, disfiguring scarring. The reaction is associated with a range of both injection sites and drugs. It was first reported by Freudenthal in 1924 following an injection of bismuth salts for syphilis. Although initial reports were following intramuscular injections, the reaction has since also been reported following subcutaneous, intravenous, and intraarticular injections. Livedoid dermatitis has been reported to occur with many different drug injections, including: penicillins, local anesthetics (e.g. lidocaine), vaccines (e.g. Dtap), corticosteroids, NSAIDs, and more. Presentation
Pathogenesis
The cause of this condition is poorly understood. Microscopic examination of affected tissue shows ischemic necrosis, and so various hypotheses exist to explain this ischemia, including vasospasm from needle prick, the injected drug, or cold compresses applied to the wound. Diagnosis
The diagnosis is mainly clinical. Skin biopsies of the site show necrosis caused by ischemia. Radiographic imaging may help to delineate the extent of the wound. Treatment
Depending on the extent and state of infection of the wound, the condition may require antibiotics, wound debridement in early stages, and corrective plastic surgery in late stages. See also
Injection site reactions
List of cutaneous conditions


== References ==