Paget's Disease of Breast

For those who are dealing with Paget's disease, I have some questions.

I was dx with ADH 18 months ago.  In January of this year a rash developed on the same breast.  It is red, scaly, itchy, and painful, but I do not have a discharge.  I've tried all OTC creams, plus steroid creams and ointments.  It may go away for a week or two, but then it's back.

I had my 6 month mammo/US last week.  Mammo was clear, but US showed dilated ducts.  My onocologist said it was just a rash and was not concerned since I have no discharge.  My BS, on the other hand, was concerned and I have to go back if it's not gone in two months.

So, my questions are:  Does paget's always present itself with a nipple discharge and does there always have to be a lump present under the nipple? 

The itching is driving me crazy and the entire breast hurts.

Thanks.