What is the diagnosis and treatment for eczema (atopic dermatitis) of the breast?

From the Guidelines

Breast eczema, also called dermatitis of the breast, can be treated with a combination of gentle skin care and medications, prioritizing the use of fragrance-free moisturizers and topical corticosteroids as first-line treatments, as suggested by recent guidelines 1. For mild cases, use fragrance-free moisturizers like CeraVe or Vanicream several times daily, especially after showering. Apply over-the-counter 1% hydrocortisone cream to affected areas twice daily for up to 7 days. For moderate to severe cases, prescription topical steroids such as triamcinolone 0.1% or mometasone furoate 0.1% may be needed, applied thinly twice daily for 1-2 weeks. Some key considerations in managing breast eczema include:

• Avoid scratching to prevent further irritation and potential infection
• Wear loose cotton clothing to reduce friction and allow the skin to breathe
• Use mild, fragrance-free soaps to minimize allergen exposure
• If there's significant itching, take antihistamines like cetirizine 10mg or diphenhydramine 25mg Breast eczema often results from irritants, allergens, or underlying conditions like atopic dermatitis, as noted in guidelines for atopic dermatitis management 1. If symptoms include crusting, oozing, or fever, see a doctor immediately as this could indicate infection. For persistent cases lasting more than two weeks despite treatment, consult a dermatologist as non-steroid options like tacrolimus ointment might be appropriate, especially for sensitive areas like the nipples, considering the latest recommendations on atopic dermatitis management 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Breast Eczema Treatment

• Topical anti-inflammatory treatments, such as topical corticosteroids, are commonly used to control symptoms of eczema, including breast eczema 2
• The relative effectiveness and safety of different topical anti-inflammatory treatments for eczema is uncertain, but potent and very potent topical steroids, tacrolimus 0.1%, and ruxolitinib 1.5% are ranked among the most effective treatments for improving patient-reported symptoms and clinician-reported signs 2
• Topical corticosteroids are classified by strength and the risk of adverse effects, such as atrophy, striae, and rosacea, increases with prolonged use, large area of application, higher potency, occlusion, and application to areas of thinner skin, such as the face and genitals 3

Application and Usage

• Correct patient application of topical corticosteroids is critical to successful use, and patients may be taught application using the fingertip unit method 3
• Topical corticosteroids are applied once or twice per day for up to three weeks for super-high-potency corticosteroids or up to 12 weeks for high- or medium-potency corticosteroids 3
• Applying potent topical corticosteroids only once a day probably does not decrease the number achieving treatment success compared to twice daily application 4

Safety and Adverse Events

• Local adverse events, such as abnormal skin thinning, are most common with tacrolimus 0.1% and crisaborole 2%, and least common with topical steroids 2
• The frequency of abnormal skin thinning is low overall and increases with increasing potency of topical corticosteroids 4
• Topical corticosteroids can work safely and effectively in patients who are pregnant or lactating 3

Alternative Treatments

• Other treatments for eczema, including atopic dermatitis, include ultraviolet phototherapy, antistaphylococcal antibiotics, and newer medications such as crisaborole and dupilumab 5, 6
• Proactive therapy with twice weekly use of topical corticosteroids and calcineurin inhibitors in previously affected areas has been found to reduce the time to the next eczematous flare 6