The authors have declared that no competing interests exist.
Topical corticosteroids are main therapeutic agents for the treatment of a wide variety of dermatological disorders. Three cases of chronic cutaneous ulceration affecting the skin of the breasts that were caused presumably by previous and continued use of potent topical corticosteroids for the treatment of psoriasis and/or intertrigo lesions were reported here. These three cases were presented to emphasize the potential serious local side effects of topical steroids even progressing to ulceration in breast' skin. These cases highlight the importance of appropriate use of topical corticosteroids, necessity of a strict follow up for adverse effects and the need of warning every patient about possible side effects of topical corticosteroids
Topical corticosteroids are main therapeutic agents in various dermatological disorders
Three cases of cutaneous ulcerations located in the skin of breasts that were caused presumably by prolonged use of potent topical corticosteroids were reported in this manuscript.
A 25-year-old female patient applied to the outpatient clinic in June 2010 with the complaint of presence of a sore located in her left breast present for 15 days. Her past medical history revealed that she had psoriasis and she had been using topical beclomethasone dipropionate 0.025 % lotion (a class four – midstrength topical corticosteroid) for years to her breasts. She was coming from rural area. Dermatologic examination disclosed a punched out ulcer approximately 3 cm in size with a clear base over the medial side of her left breast and a similar ulcer 4 mm in size over the medial side of her right breast (
A 79 year old female patient applied to the dermatology outpatient clinic with the complaint of presence of a skin sore located in her right breast for two months. She had been experiencing itching and redness of her breasts for about one year. She irregularly used topical clobetasol 17 propionate 0.05 % ointment (a class one – super potent topical corticosteroid) and combined difluocortolon valerate (a class three – potent topical corticosteroid) and isoconazole cream to her breasts by herself. Her past medical history revealed that she was in menaupose, had cardiac failure and hypertension. She was coming from rural area. On dermatologic examination a punched out ulcer approximately 3 cm in size with a clear base and somewhat elevated borders was detected over the lateral side of her right breast (
A 62 year old female patient applied to the dermatology outpatient clinic with the complaint of redness and development of sores in the skin of her breasts present for four months. She had been intermittantly experiencing itching and redness involving her inframamarian areas for about five years. She irregularly used topical combined difluocortolon valerate (a class three – potent topical corticosteroid) and isoconazole cream by herself. Her past medical history revealed that she was in menaupose, had diabetes mellitus, hypertension and hyperlipidemia. She was coming from rural area. Superficial punched out ulcers with erythematous clear bases were detected over the inframamarian regions bilaterally on dermatologic examination (
Topical application of corticosteroids can cause cutaneous atrophy due to a suppressive action on both cellular proliferation and collagen synthesis
To date topical medications containing betametasone or a combination of corticosteroid and antifungal / antibacterial agents were the most common topical therapeutic agents to cause topical corticosteroid adverse effects
The differential diagnoses of ulceration of breast skin may include infectious diseases, pyoderma gangrenosum, ulceration due to haematologic disorders and malignant disorders. All of these disorders are excluded by the clinical presence of punched out clear skin ulceration without induration in the background of widespread cutaneous steroid atrophy. Moreover ulcers are located in the most opposing points of the breasts. All of the ulcers healed with wound treatment.
These three cases were presented to emphasize the potential serious local side effects of topical steroids even progressing to the development of cutaneous ulceration. It is important to use appropriate topical corticosteroid in appropriate location for an appropriate duration and we should not forget the necessity of follow up. The best approach to prevent these serious side effects is to inform patients about these side effects. Physicians are advised to refrain from prescribing any topical steroid medication (especially the ones combined with other molecules) to patients belonging to low socio-cultural level to treat intertrigo or chronic cutaneous disorders like psoriasis in intertriginous skin. These rules must especially be obeyed when there is a strong suspicion that the patient will not come back for a control examination.