7. Pain or Tenderness: Distressing Signals
As we continue our exploration of the symptoms of Extramammary Paget’s disease (EMPD), we come across a symptom that might not be present in the early stages but is a cause of considerable distress as the disease progresses. This symptom is the experience of pain or tenderness in the affected area.
In the early stages of EMPD, most symptoms are confined to changes in the skin’s appearance. The disease usually starts as an asymptomatic or minimally symptomatic skin lesion, often leading to delayed diagnosis. As the disease progresses, however, symptoms become more pronounced, and one of the distressing manifestations of this progression is the onset of localized pain.
The development of pain in EMPD is tied to the underlying pathophysiological changes happening as the disease progresses. EMPD begins when the apocrine gland cells transform into cancerous cells. As these cells multiply, they invade the epidermis and sometimes the dermis. This invasion and subsequent inflammation of the skin layers can stimulate nerve endings and result in pain sensations.
The severity and type of pain can vary greatly among patients. For some, it might be a mild, nagging ache that is more of an annoyance than a hindrance. For others, it can be severe, sharp pain that disrupts their daily activities and impairs their quality of life. The affected area may also exhibit tenderness, where the skin becomes sensitive to touch or pressure.
Clothing or any form of friction may exacerbate this tenderness, making it a significant source of discomfort. For some, the pain can also have a burning or stinging quality, particularly if there are skin erosions or ulcers.
Pain or tenderness associated with EMPD is usually persistent. Unlike the transient pain that we experience due to minor injuries or non-severe illnesses, EMPD-related pain tends not to resolve on its own and may even worsen over time. It is often resistant to over-the-counter pain relief medications, further emphasizing the importance of seeking medical attention. (7)
