Acute Unilateral Inflammatory Breast Rash in Young Healthcare Worker

Case at a Glance

A 26-year-old female surgical nurse presented with acute onset of severe unilateral breast rash characterized by erythema, swelling, and intense pruritus developing during work hours.

Patient's Story

The patient is a 26-year-old female, height 5'7", weight 260 pounds, working as a surgical nurse. She has a medical history significant for eczema affecting her hands and a chronic hyperkeratotic condition of her feet with associated toenail fungal infections. There is a strong family history of similar fungal conditions on her paternal side, with her father having successfully treated a similar condition with oral itraconazole. The patient reports hyperhidrosis and regularly wears sports bras during long work shifts, sometimes fitted tightly due to weight fluctuations. On July 3rd, while working a busy shift in the operating room, she experienced sudden onset of severe stinging pain and intense itching beneath her right breast. Upon examination at home after removing her bra, she discovered a bright red, raised, swollen rash with darker central areas corresponding to pressure points from her bra.

Initial Assessment

Physical examination revealed an erythematous, edematous rash localized to the inframammary fold of the right breast. The rash appeared raised and inflamed with areas of deeper erythema centrally. The patient described intense pruritus and burning sensation that was most severe on the first day. The texture of the skin appeared normal despite the visible inflammation and swelling.

The Diagnostic Journey

The patient's presentation, combined with her occupational environment (prolonged wearing of tight-fitting undergarments during physically demanding work), predisposing factors (obesity, hyperhidrosis, family history of fungal infections), and clinical appearance suggested intertrigo with possible secondary fungal infection. The unilateral presentation in an inframammary fold, coupled with mechanical irritation from ill-fitting undergarments, supported this diagnosis.

Final Diagnosis

Intertrigo of the right inframammary fold with suspected secondary fungal infection (candidal or dermatophyte)

Treatment Plan

Initial management included topical antifungal therapy (clotrimazole or miconazole) combined with low-potency topical corticosteroid (hydrocortisone) for anti-inflammatory effect. Supportive care measures recommended included keeping the area clean with unscented soap, maintaining dryness with absorbent cloth barriers, application of cornstarch powder after antifungal absorption for moisture control and friction reduction, and ensuring proper-fitting supportive undergarments. Long-term management focused on weight reduction toward ideal BMI and addressing underlying hyperhidrosis.

Outcome and Follow-up

Patient was advised to continue topical therapy as directed and implement moisture control measures. Instructions were given to seek medical evaluation if no improvement occurred within several days or if symptoms worsened. Given the patient's anxiety regarding health concerns, reassurance was provided about the benign nature of the condition while emphasizing the importance of proper treatment adherence and follow-up care.