Zuska

Zuska disease, commonly referred to as Zuska’s disease or periductal mastitis, is a chronic inflammatory condition of the breast ducts located beneath the areola. It presents with recurrent subareolar abscesses, sinus tract formation, and sometimes nipple discharge. The condition is most often described in middle-aged women and is associated with risk factors such as smoking, ductal obstruction, and chronic inflammation, though variants can occur in men and younger individuals.

Cause and pathophysiology are not fully understood. The prevailing view is that subareolar duct obstruction leads to inflammation and secondary infection. Epithelial changes in the duct lining, including squamous metaplasia, may contribute to ductal blockage. Chronic inflammation promotes duct dilation, abscesses, and fistulas beneath the areola. The disease tends to be recurrent and can be difficult to distinguish from malignant processes without imaging and, in some cases, biopsy.

Clinical features typically include painful swelling under the areola, recurrent purulent or serous discharge, tender nodules, and occasional sinus tracts that may intermittently drain. Fever and systemic symptoms are uncommon unless an active infection is present.

Diagnosis is based on clinical evaluation supported by imaging. Ultrasound is commonly used to identify ductal dilation, abscesses, and fistulas; mammography or MRI may be employed to exclude malignancy. Microbiological culture of purulent discharge can guide antibiotic therapy, though organisms are often mixed and culture results may be negative.

Treatment aims to control infection, relieve symptoms, and prevent recurrence. Acute infections are treated with appropriate antibiotics and drainage if an abscess is present. For chronic disease, surgical management—typically removal of the affected subareolar ducts, sometimes with fistulous tracts (central duct excision or Hadfield-type procedures)—is frequently curative. Smoking cessation is recommended. Prognosis varies; many patients experience symptom relief after surgery, though recurrence can occur if residual ducts remain.