A Novel First-Line Treatment Alternative for Noncomplicated Idiopathic Granulomatous Mastitis: Combined İntralesional Steroid İnjection with Topical Steroid Administration

Abstract

<b><i>Background:</i></b> Idiopathic granulomatous mastitis (IGM) is a rare form of nonlactational mastitis. Due to the small number of case series and consequently inadequate prospective studies, there is still no consensus on the optimal treatment of IGM. In this study, we aimed to compare the efficacy of intralesional steroid injection with concomitant topical steroids to systemic steroid therapy only in the treatment of noncomplicated IGM. <b><i>Methods:</i></b> Between June 2015 and April 2018, the patients’ data was prospectively collected and analyzed retrospectively. The study included a total of 78 female patients diagnosed with IGM. Patients were divided into 2 groups: the local steroid treatment group (intralesional steroid injection with topical steroid administration; group 1, <i>n</i> = 46) and the peroral systemic steroid treatment group (group 2, <i>n</i> = 32). Response to the therapy, side effects, recurrence, the need for surgical treatment, and complication rates were compared. <b><i>Results:</i></b> Forty-three patients (93.5%) in group 1 achieved a partial or complete response compared to 23 patients (71.9%) in group 2 after 3 months; this difference was significant (<i>p</i> = 0.012). The recurrence rates were significantly lower in group 1 (8.7%) compared to group 2 (46.9%; <i>p</i> = 0.001), and the need for surgical treatment was significantly less in group 1 (2.2%) than in group 2 (9.4%; <i>p</i> = 0.001). While the complication rates were similar between groups, a higher rate of systemic side effects was observed in group 2. <b><i>Conclusion:</i></b> Based on the results of our study, combined steroid injection and topical steroid treatment in IGM is as effective as systemic steroid treatment. We suggest that this combination therapy of topical steroids and local steroid injection should be used as first-line therapy in patients with noncomplicated IGM.

Local Steroid Treatment: An Effective Procedure for Idiopathic Granulomatous Mastitis, Including Complicated Cases

“…In addition, the ndings in patients exhibiting partial recovery that the lesion size did not increase and the disease did not progress may be an indication that the steroid restricts the disease by suppressing active in ammation. In a similar study, Toktaş et al [10] reported that 93.5% of the patients undergoing LST responded to the treatment. These results show that LST is an effective method in the treatment of IGM.…”

“…In addition, 38.2% of patients developed systemic side effects, such as hirsutism, weight gain and iatrogenic Cushing syndrome related to systemic steroid use. Toktaş et al [10] also reported local side effects at a rate of 2.2% in their LST group, and systemic side effects at a rate of 9.4% in the group treated with systemic steroids. It is notable that systemic treatment was not reported to be superior to local applications in terms of treatment e cacy in either of these studies.…”

“…In contrast, the absence of recurrence in LST may indicate that the steroid suppresses active in ammation completely. Moreover, resection in IGM can cause undesired cosmetic results [8,10,28]. Due to high recurrence rates and poor cosmetic results, patients may require multiple operations and some of these patients even require mastectomy [29].…”

“…The use of medical treatment is increasing due to the cosmetic problems caused by surgical treatments. One medical treatment option includes systemic steroid therapy, which has high effectiveness, but its use is limited due to the wide range of side effects [10]. Use of local steroids is becoming widespread to avoid these systemic side effects.…”

Treatment Results of Local Steroid Administration in Breast-Feeding Women with Idiopathic Granulomatous Mastitis

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Surgery has cosmetic and healing challenges for breast-feeding patients; on the other hand, in some patients, corticosteroids can have side effects and must be used for a long period to get an adequate response. In recent studies, local corticosteroids were found to be effective, better tolerated, and having fewer side effects [1,[9][10][11]. In our study, we assess intralesional steroid injection with concomitant topical steroids in the treatment of IGM in breast-feeding women.

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