Isolated erythema (cellulitis) of the breast

This paper reports nine cases of breast cellulitis in women patients (four cases in pregnancy, four postmenopausal cases following hormone replacement therapy and one case of unilateral breast oedema following a mediastinal lymphoma). Biopsies were obtained from the erythematous area in one pregnant patient, one postmenopausal patient and the patient with breast oedema associated with the mediastinal lymphoma. Histology revealed unspecific dermatitis with extensive perivascular lymphoplasmocellular infiltrates. Histopathological examination of biopsies obtained from the underlying mammary tissue along with the corresponding mammographic data gave no evidence of mastitis or mammary carcinoma. The patients complained of sensitivity to touch, a feeling of local tightness or a burning sensation. These findings were reported in both breasts in the pregnant patients, but were unilateral in the others. The submammary fold was unremarkable, that is, no intertrigo was detected. The aetiology of the erthyema is probably associated with swelling of the breast tissue and a causal link with a specific endocrine constellation (pregnancy, postmenopausal HRT) can be postulated. A common factor in all cases presented here is the relatively long period of 4 to 13 weeks before healing of the lesion. Therapeutic intervention with antibiotics or dopamine agonists failed to influence the course. Similarly, steroid cream appeared to be of no value in these cases. Extensive erythema of the breast skin is a benign disease, for which there is still no known effective therapy. The lack of mammographic evidence and, especially, of positive palpatory findings make breast cancer highly improbable as the underlying cause.