What is the treatment for a small, red, itchy lesion under the left breast with a pinpoint opening?

Treatment for a Nickel-Sized Pimple Under Left Breast

The most appropriate treatment for this nickel-sized pimple under the left breast is application of a topical antibiotic ointment 1-3 times daily for 7-10 days, with possible coverage using a sterile bandage. 1, 2

Assessment of the Lesion

The description indicates a lesion with the following characteristics:

• Nickel-sized pimple under left breast
• Present for 1 week
• Red appearance
• Pinpoint opening at center (has popped)
• No drainage
• No pain
• Mild itching

Treatment Algorithm

First-Line Treatment

1. Clean the affected area thoroughly with mild soap and water

2. Apply topical antibiotic ointment such as:

   • Triple antibiotic ointment (neomycin/polymyxin B/bacitracin) 3
   • OR Bacitracin ointment 1
   • Apply a small amount (equal to the surface area of fingertip) 1-3 times daily
   • May cover with a sterile bandage if desired

3. Duration: Continue for 7-10 days 4

Rationale for Topical Antibiotic Treatment

• Topical antibiotics effectively eradicate resident bacteria through multiple layers of the stratum corneum 5
• Triple antibiotic ointment is active against common skin pathogens 3
• The location under the breast creates a warm, moist environment that increases infection risk
• The mild itching suggests possible inflammatory or infectious process

Special Considerations

Location-Specific Concerns

The inframammary fold location requires special attention:

• Keep the area clean and dry
• Consider using a clean cotton cloth between breast and chest wall to reduce moisture
• Avoid tight-fitting bras that may irritate the area

When to Seek Further Evaluation

Return for further evaluation if:

• Lesion increases in size or redness
• Develops drainage or purulence
• Pain develops or worsens
• Fever develops
• No improvement after 7-10 days of treatment

Potential Complications to Monitor

1. Allergic contact dermatitis: Occurs in a small percentage of patients using topical antibiotics, particularly neomycin 6

   • Watch for increased redness, swelling, or itching that worsens with application

2. Inadequate response: If no improvement after 7-10 days, consider:

   • Alternative diagnosis
   • Need for incision and drainage
   • Possible need for oral antibiotics

Evidence-Based Considerations

Topical antibiotic ointments have been shown to:

• Prevent infection in minor wounds 7
• Eradicate resident bacteria through multiple skin layers 5
• Maintain a moist wound environment conducive to healing

While some studies suggest petroleum-based ointments without antibiotics may be sufficient for clean wounds 8, the location under the breast and presence of a pinpoint opening justify the use of topical antibiotics to prevent secondary infection.