Breast Rashes: When to go to the doctorby Phyllis Johnson Patient Advocate
Breast rashes are so common, yet so varied, that they lead to much confusion. How can you know which are harmless ones that can be treated with home remedies? Are some rashes dangerous, or even deadly? When should you seek a doctor’s advice?
You can prevent some types of breast rashes by keeping the area cool and dry. Wash your skin and clothes with products for sensitive skin and rinse well. A bra made from a breathable fabric is also important if you are having itchiness or rashes. Never wear your bra to bed. Allowing the skin to breathe can reduce the opportunity for organisms to gain a foothold in the warm, dark environment of your breast. Despite all of your efforts to protect against rashes, sometimes they still creep in, but there are often ways to remedy them at home!
Problems that often respond to home remedies.
_Dermatitis. _This general term refers to an inflammation of the skin. There are a whole host of minor allergic reactions which fall into this category such as poison ivy or oak, or even allergies to tattoo dyes or piercings. These types of allergic reactions may be self-limiting and respond well to an oral antihistamine or anti-itch cream such as calamine lotion. If you don’t see an improvement in a day or two, or if the situation gets worse, you will need to call the doctor. Most of the time these types of skin allergies aren’t dangerous, but if you have trouble breathing, call 911.
Heat rash, sometimes called prickly heat, is common on the underside of the breast, especially in hot weather. It is characterized by little red or white bumps. Keeping the area cool and dry will help. If the area gets worse or looks infected, you may need to call the doctor, but usually heat rash will clear up on its own.
Boils are red, painful, pus-filled bumps that usually will get better with warm compresses. Don’t try to lance them yourself. If you get boils frequently, the doctor may want you to try an oral antibiotic or special antibacterial skin cleansers.
Rashes that might need a doctor’s attention. Some skin conditions aren’t inherently dangerous, but it may take a doctor to properly diagnose and treat them.
Fungal causes of rashes. Ringworm and candida (yeast) infections are caused by microorganisms in the fungus family. They may show up anywhere on the body, especially skin folds and areas that are difficult to keep dry such as the underside of the breast. Thrush is another fungal infection that babies may get and then pass along to the mother while nursing. In some cases a cream will clear up fungal rashes. Sometimes an oral medicine may be necessary. Usually you will need to persist with treatment. The redness may go away in a day or two, but require a longer course of treatment to work completely.
Scabies is caused by a mite that burrows under the surface of the skin. A doctor will need to write a prescription to get rid of the mites.
Telangiectasias (small widened blood vessels on the skin) and radiation dermatitis. If you have been treated with radiation for breast or other cancers in your chest area, your breast may develop red, mottled areas. When these develop, you will want the doctor to take a look just in case they herald a cancer recurrence, but generally speaking these are harmless responses to radiation.
Distinguishing the cause of a rash is important because an antifungal cream for a yeast infection might make dermatitis worse. Anytime you try a home remedy and don’t see an improvement within a few days, it is wise to consult a doctor to make sure you know exactly what you are dealing with.
Problems that need treatment before they become dangerous.
Shingles is a viral infection that causes a burning, stinging rash in people who have had chicken pox when they were younger. The rash is usually on one side of the body and often has raised blisters. There is a vaccine to prevent it in people over 50, so talk to your doctor about whether the vaccine would be advisable for you. If you do wake up one morning with a red burning rash anywhere on your body, including your breast, call the doctor right away. Immediate treatment with an anti-viral medicine is important. Untreated shingles can cause pain for months or even years.
Mastitis, mammary duct ectasia, and breast abscesses are infections that start inside the breast. In addition to pain, swelling and redness, they may also cause a fever. You will almost certainly need an antibiotic, so call the doctor right way if you think you might have one of these infections.
Cellulitis _is a bacterial skin infection that can occur anywhere on your body. It would be most likely to develop in your breast area where you had some sort of break in your skin. It can develop after surgery, so be sure to call the doctor if you develop redness or pain around a surgical scar. It often spreads rapidly and causes a fever. It can be quite dangerous if not promptly treated.Dangerous conditions that might first show up on your breast. Lyme disease or other tick-borne illnesses._ A few days after you find a tick bite, you might see a bull’s eye pattern, which is the hallmark of Lyme disease. Even if you don’t find a tick or see a rash, call the doctor if you develop flu-like symptoms after being in areas where you might have been exposed to tick bites. Lyme disease can cause problems with the joints, nerves and heart, so cover up and use tick repellent to avoid being bitten. See the doctor right away if there is a possibility that you have a tick-borne illness.
Paget’s Disease of the Breast. _Unlike Lyme Disease or regular eczema which could start on any part of your body, Paget’s Disease of the Breast is a type of breast cancer visible on the nipple. It begins as a red, scaly, itchy rash on one breast. Call your doctor if you have an eczema-like rash that doesn’t clear up. If you have some dry scaliness on both breasts and if you are prone to eczema, don’t panic. It is much more likely that you have a dry skin problem and not cancer. Fortunately, Paget’s Disease of the Breast is a highly treatable form of breast cancer. Inflammatory Breast Cancer (IBC). This type of breast cancer is often misdiagnosed as one of the above types of breast problems, especially as mastitis. Because breast cancer cells block the lymph vessels in the skin of the breast, the breast usually swells and turns red and warm. The patient often experiences pain and itching inside the breast, and the skin may develop pitting like the skin of an orange. Not every patient will have every symptom, so it is important to see the doctor right away for pain, swelling, and discoloration in just one breast. Often the doctor will try an antibiotic first because the symptoms look like an infection and infections are more common than IBC. While you wait to see if the antibiotic works, imaging tests can be done. Although most patients with IBC don’t have a lump that will show up on a mammogram, most will show some changes in density, symmetry or other factors on a mammogram that will help the surgeon know where to biopsy if necessary. If one round of antibiotics does not clear up the symptoms, patients need to ask for a referral to a breast surgeon for a biopsy to rule out IBC. IBC is an aggressive form of breast cancer, and if you have it, you will need to begin a system treatment like chemotherapy, which is usually followed by surgery and radiation. Breast Cancer Skin Metastasis._ After treatment for breast cancer, the cancer may recur near the original surgical scar. If you notice pea-sized nodules or red, raised areas in your skin or on your scar, call these to your oncologist’s attention. Your doctor will probably want to do a biopsy to make sure that the cancer hasn’t come back.
Fortunately, most breast rashes are not dangerous and will respond well to treatment when they are properly diagnosed. This article doesn't include every possible problem that could cause changes in color or texture in your breast skin. Never be hesitant to call the doctor for a rash that lasts longer than a few days or that doesn’t clear up quickly with home remedies.
For More on Breast Cancer Treatments:
Dermatology A to Z. American Academy of Dermatology. September 23, 2015.
Love, S., K. Lindsey and E. Love. Dr. Susan Love’s Breast Book, 6th ed. Boston: Da Capo Press. 2015.