What is the best topical agent (lotion, cream, or ointment) to use under the breast for skin care?

Topical Vehicle Selection for Under-Breast Skin Care

For under-breast skin care, creams or ointments are preferred over lotions, as alcohol-containing lotions should be avoided in favor of oil-in-water creams or ointments for intertriginous areas prone to moisture and friction. 1

Vehicle Selection Based on Skin Condition

For Dry or Irritated Skin

• Use oil-in-water creams or ointments rather than lotions for areas under the breast 1
• Alcohol-containing lotions or gels should be specifically avoided as they can cause excessive drying and irritation 1
• Apply emollients at least once daily, preferably twice daily, to maintain skin barrier function 1

For Isolated vs. Multiple Lesions

• Cream is preferred for isolated scattered lesions in the under-breast area 1
• Lotion may be considered only for multiple scattered areas, though creams remain superior for intertriginous zones 1

Specific Formulation Recommendations

Moisturizing Agents

• Urea-containing moisturizers (5%-10%) in cream base are recommended twice daily for optimal hydration 1
• These should be alcohol-free formulations to prevent barrier disruption 1

When Adding Active Ingredients

• For inflammatory conditions under the breast, topical corticosteroids should be formulated as creams (e.g., hydrocortisone 2.5%, alclometasone 0.05%, or prednicarbate 0.02%) 1
• Topical antibiotics, if needed, work well in cream formulations (clindamycin 2% or erythromycin 1% cream) 1

Key Clinical Considerations

Why Avoid Lotions Under the Breast

• The under-breast area is an intertriginous zone prone to moisture accumulation and friction 1
• Alcohol-containing lotions can paradoxically worsen dryness and cause irritation in these sensitive areas 1
• Lotions provide less occlusion and barrier protection compared to creams or ointments 1

Ointment vs. Cream Selection

• Creams are generally preferred as they provide adequate occlusion without excessive greasiness 1
• Ointments may be reserved for severely dry, fissured, or eczematous skin requiring maximum barrier protection 1
• Ointments can feel uncomfortable in warm, occluded areas like under the breast, making creams more practical 1

Application Strategy

• Apply moisturizing cream at least twice daily to the entire under-breast area 1
• Avoid hot water washing and excessive soap use, which strip natural oils 1
• If using medicated creams, apply a thin film to affected areas as directed 1
• For nursing women specifically, emollient creams are safe and should be applied after feeding 2