Effect of Topical Steroid Treatment on Idiopathic Granulomatous Mastitis: Clinical and Radiologic Evaluation

Abstract

Idiopathic granulomatous mastitis (IGM) is a rare inflammatory, noncaseating, chronic granulomatous benign disease. The etiology of IGM is still unknown. It is postulated to be an autoimmune localized response. The use of a course of oral steroids provides an important regression of breast mass and skin lesions. Topical corticosteroids are used to treat many skin diseases, but no study is available on the sole use of topical steroids for treating IGM. Eleven women with IGM were treated with topical steroid and evaluated using mammography, ultrasonography, and dynamic MRI. At the end of the 12th week, patients were clinically and radiologically evaluated for the regression of breast and skin lesions. Pre- and post-treatment time-intensity curve patterns (TICs) were also compared. During the topical steroid treatment, the inflammation signs in the affected breast had markedly disappeared, the fistulas had become inactive, and the fistula orifices and/or skin erosions had closed in nine patients. The median follow-up period was 17 months (range: 12-48 months). Recurrence was observed in two patients (2/11) at 5 and 8 months, which were treated again topically. The inflammatory findings of the breast skin completely resolved after 8 weeks of treatment, and no side effects or steroid-related complications occurred. In the pretreatment period, TICs from enhancing areas showed a Type 1 pattern in three cases, a Type 2 pattern in five cases, and a Type 3 pattern in three cases. After topical steroid treatment, TIC was not changed only in one patient (Type 2). Type 1 patterns were determined in seven cases and Type 2 patterns in two cases. In addition, in two patients, TICs were not determined due to complete healing. Our MRI findings showed that topical steroid therapy may be useful because it affects mammary parenchyma as well as mammary skin. Further studies with a greater number of patients are needed to determine the topical steroid therapy dosing and duration, and to better understand the efficacy for treating IGM.

Idiopathic granulomatous mastitis: A systematic review of 3060 patients

“…The characteristic of reviewed articles is summarized in Table (). The total number of articles was 70, 59 in group A and 11 in group B.…”

Granulomatous Mastitis: A Therapeutic and Diagnostic Challenge

“…In the patient shown in figure 1, the authors observed a 50% reduction of the breast mass after 3 weeks of therapy with topical hydrocortisone acetate. No side effects occurred [35]. …”

The evaluation of the efficacy of local steroid administration in idiopathic granulomatous mastitis: The preliminary results

“…One reported case successfully treated by using a treatment combination of low‐dose oral + topical steroid applications . The first study with local steroids, conducted as a topical application on the skin only, was performed by Gündüz et al In their study, steroid treatment was performed as a topical application to the skin for 12 weeks in 11 patients with IGM. According to the study were as effective in parenchyma as they were in cutaneous lesions.…”