Question re: rash in breast tx field

[iradi8u]

---

Members don't see this ad.

I've seen quite a few of my breast ca patients develop an intensely pruritic, mixed macular and papular rash in the treatment field. It always starts in the upper inner-most aspect of the field and then spreads. The base is erythematous above and beyond the acute treatment-related erythema, and it has not been painful.
It looks like a candida rash to me, so I've been using Mycalog II cream - seemingly to no avail. No other symptoms.

Has anyone seen this? It's been in nearly 50% of my breast patients, no other patient population. They don't use the same topical creams. I'm not sure if it's a regional thing - I moved to the Southwest from the East Coast, where I never saw any of this.

Any thoughts would be greatly appreciated. Thanks!

 

[Gfunk6]

I see this phenomenon very often in my breast cancer patients. I usually recommend 1% hydrocortisone or Benadryl cream. This usually clears up the pruritus. The rash itself, of course, goes away a couple of weeks after radiation is complete.

If not pruritic, then I tell to moisturize it twice per day (like I ask them to do for the entire treated breast).

 

[Pointless]

I have run into this a bunch as well; the best explanation I have found is folliculitis caused by radiation. I have seen in happen during and after RT is over. Agree with 1% hydrocortisone, I've had good success with that.

 

[iradi8u]

Thank you!

 

[Neuronix]

I agree with Pointless and Gfunk. Can add topical/oral diphenhydramine if the itching is bothersome. In theory you could use topical/oral antibiotics for severe cases, but these episodes have always been self-limited in my experience so I never have.

 

[medgator]

Sometimes I end up using Rx hydrocortisone (2.5%) or, in rare cases, triamcinilone, if it does not respond to OTC HC.

 

[Brim]

The "V"-shaped rash, which is often maculopapular and always found in the upper inner quadrant, is due to chronic solar dermatitis (think low-cut blouse...) sustained over the woman's lifetime, exacerbated by radiotherapy. It's fairly common. The above mentioned treatments (steroids, antihistamines) seems to work well in most cases.