Q: My wife, age 72, was diagnosed with breast cancer in April 1994. She had a lumpectomy followed by chemo and radiation treatments. She has been cancer free since then. In the past year she has developed a fungus/rash under the breast that had the cancer. Her oncologist prescribed Clortrimazole 1%. It has not helped her and she continues to experience significant pain and discomfort, especially at night.
Can you recommend anything that might give relief and allow her t get a good night’s sleep?
A: It’s very interesting that your letter was chosen to be addressed today, since it’s being written on June 11th – National Cancer Survivor’s Day (even though it will not appear in print until the 23rd) and your wife was among those survivors honored. Congratulations to her.
Many individuals complain of “rashes” under their breasts, particularly if the weather is warm and support garments rub against tender skin. Bacteria and fungi, can appear anywhere on the body but prefer more conducive moist/warm areas such as belt lines and under breasts. One of the more common causes of an itchy rash in such areas is known as Candida, a type of yeast or fungi. Candida appears as white when in the mouth, on a microscope slide as clear and white, and when on the skin it may be red and raw. This type of yeast is common in individuals with diabetes, in antibiotic or chronic steroid use, in obese individuals, and in those with a compromised immune system such as HIV.
Candida may respond well to topical anti-fungal creams such as ketoconazole or anti-fungal powders that will help keep the area(s) dry. Your wife might find less irritation on the tender sites if she were to remove her bra once at home for the day which will allow her skin to dry naturally. She should also pat the affected areas dry following bathing, rather than rubbing them with a harsh towel which may further aggravate the lesions.
Bacteria such as staphylococcus and streptococcus may also be to blame. Again, diabetes and a compromised immune system will increase a person’s risk of getting an infection. The rash from bacteria is commonly red and is often warm to the touch. In this instance, oral antibiotics such as amoxicillin, clarithrymycin, dicloxacillin and others might bring her condition under control.
A skin allergy (allergic dermatitis) may also lead to a rash. Individuals with season allergies, eczema, and asthma are at an increased risk of developing a skin allergy. Common irritants include laundry detergents, topical moisturizing lotions and perfumes are often the culprit. The intensity of this type of allergy will vary from person to person. Topical steroids such as hydrocortisone are the treatment of choice. Keep in mind that the long-term use of topical steroids should be avoided, since they have the potential of leading to chronic skin changes that may promote the overgrowth of Candida and other fungi.
Psoriasis is a type of skin disorder commonly found on elbows and knees, so while mentioning it, I don’t believe your wife’s rash is from this cause. However, a subtype of psoriasis is known as inverse psoriasis that is known to develop in skin folds under the arms or breasts and in the groin area. According to the Journal of the American Board of Family Medicine, inverse psoriasis is commonly mistaken for a Candida infection. Topical steroids may be effective but keep in mind that psoriasis will not improve with anti-fungal creams.
Your wife may need a different antifungal medication or some of the modalities I have mentioned thus far. Further, she might even consider asking her oncologist for a referral to a dermatologist who might have additional ideas for controlling her rash.
On the home front, she might place a layer of soft cotton material such as that from a T shirt to help absorb moisture. Or, cornstarch can be applied to the area that is dry to the touch. Calamine lotion, the pink liquid used to treat poison ivy might provide relief of the itch, while helping the affected skin heal. It should be applied twice daily. Lastly, she might consider applying a cold compress of skim milk and cold water to sooth the itch and reduce the swelling and pain level.