This is a picture of Paget's disease, a rare form of breast cancer which appears as a unilateral, well demarcated, red, scaly plaque involving the nipple/areola. 60% of the time there is an underlying breast mass. The parent should see a health care provider for diagnosis and treatment immediately, making a wait and see approach inaccurate.
It is not in the IBCLCs scope of practice to diagnose conditions or prescribe medications, which makes the eczema diagnosis and hydrocortisone recommendation additionally inaccurate.
Wambach writes "Although breastfeeding lowers the risk of developing breast cancer, it does not prevent the rare woman from having a cancerous lump in her breast while she is breastfeeding". (Wambach 2016 p 347-348; Wambach 2021 pp 303-304). Additionally, lactation consultants should seek to validate and not dismiss parent concerns.