From the Guidelines
For treating skin candidiasis under the breast in the UK, I recommend using an antifungal cream such as clotrimazole 1% (Canesten), miconazole 2% (Daktarin), or econazole 1% (Ecostatin) as the first line of treatment, as suggested by the Infectious Diseases Society of America guidelines 1.
Treatment Approach
The treatment approach for skin candidiasis under the breast involves:
- Applying the antifungal cream to clean, dry skin twice daily for 1-2 weeks, continuing for a few days after symptoms resolve
- For more severe cases, oral fluconazole 150mg as a single dose or ketoconazole tablets may be prescribed by a GP
Prevention of Recurrence
To prevent recurrence of skin candidiasis under the breast:
- Keep the area dry by gently patting the skin after washing, using a hair dryer on cool setting, or placing a clean cotton cloth between skin folds
- Wear a well-fitting, cotton bra and change it daily to reduce moisture
- Dust the area with antifungal powder or use absorbent powders like talc-free baby powder to maintain dryness
Important Considerations
These infections occur because the warm, moist environment under the breast creates ideal conditions for yeast (Candida) to multiply, especially in those with larger breasts, diabetes, or during hot weather 1. It is essential to note that the treatment of skin candidiasis under the breast should prioritize reducing moisture and preventing recurrence, as suggested by the guidelines 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Sufficient Econazole Nitrate Cream, 1% should be applied to cover affected areas once daily in patients with tinea pedis, tinea cruris, tinea corporis, and tinea versicolor, and twice daily (morning and evening) in patients with cutaneous candidiasis
- Treatment of skin candidiasis: Apply econazole nitrate cream 1% twice daily (morning and evening) to the affected area under the breast.
- Duration of treatment: Treat for two weeks to reduce the possibility of recurrence. 2
From the Research
Treatment Options for Skin Candidiasis on the Breast
- Topical therapies, such as azole drugs (miconazole, clotrimazole, and ketoconazole), are effective in treating skin candidiasis, including under the breast in the UK 3.
- Clotrimazole, nystatin, and miconazole are the most studied topical drugs and have demonstrated similar efficacy with complete cure rates of 73%-100% 4.
- For cutaneous candidiasis, including skin candidiasis on the breast, topical therapies are often preferred over systemic treatments, unless the infection is widespread or involves hair follicles or nails 3, 4.
Specific Considerations for Breast Candidiasis
- Diagnosis and treatment of candidiasis of the nipple and breast in breastfeeding women can be complicated due to varying symptoms and differential diagnoses 5.
- Treatment options for breast candidiasis, including under the breast, may involve topical antifungal agents, such as clotrimazole or miconazole, and addressing any underlying conditions that may be contributing to the infection 5.
Systemic Treatment Options
- Oral fluconazole has been shown to be effective in treating cutaneous candidiasis, including skin candidiasis on the breast, and may be considered for systemic treatment 4, 6.
- A combined approach using both systemic (fluconazole) and topical (metronidazole + clotrimazole) therapy may be considered for recurrent candidiasis 6.