Topical Steroids Are NOT Used for Milk Blebs or Blocked Ducts
Topical steroids have no established role in the treatment of milk blebs or blocked ducts during lactation, and should be avoided as they do not address the underlying mechanical obstruction and may theoretically prolong the condition.
Why Topical Steroids Are Inappropriate
Mechanism of Pathology
- Milk blebs are blister-like fibrinous lesions that form on the nipple surface due to superficial extension of underlying ductal plugging, representing a mechanical obstruction rather than an inflammatory process requiring immunosuppression 1
- Blocked ducts represent milk stasis within the lactiferous ducts, which is a mechanical problem requiring improved milk removal, not anti-inflammatory treatment 2
Theoretical Harm from Steroids
- Topical corticosteroids can prolong viral shedding in animal models of viral infections, suggesting they may extend infectious periods rather than resolve them 3
- While this evidence comes from viral conjunctivitis studies, the principle of avoiding immunosuppression during active pathological processes is relevant 3
Appropriate Management Strategies
For Milk Blebs
- Management focuses on mechanical removal of the fibrinous plug and addressing concurrent hyperlactation and mammary dysbiosis 1
- These lesions can result in orifice obstruction and progress to mastitis if not properly managed 1
For Blocked Ducts
- Primary treatment involves decreasing milk synthesis rate and improving milk removal from the breast 2
- Therapeutic ultrasound has demonstrated benefit, with patients requiring an average of 3.3 treatments to experience symptom improvement 4
- Ultrasound therapy showed no adverse reactions and improved breastfeeding outcomes in 25 postpartum women with blocked ducts 4
When Infection Develops
- Antibiotic therapy is reserved for ascending lactiferous duct infections and mastitis, not for uncomplicated blocked ducts 2
- The spectrum progresses from milk stasis → blocked ducts → inflammatory mastitis → infectious mastitis → breast abscess 2
Clinical Pitfall to Avoid
Do not confuse blocked ducts with inflammatory skin conditions that do respond to topical steroids (such as eczema, psoriasis, or lichen sclerosus). The breast pathology during lactation requires mechanical solutions, not immunosuppressive therapy.