Psoriasis of Areola & Nipples recommendations for management

[Janette Brooke]

Hullo Tom,
An ante-natal Mother who consulted me for the first time yesterday, has mild, controlled psoriasis at the base of her scalp and areola/nipples. She occasionally uses Mometasone furoate (Elecon) lotion on the scalp area and sorbolene cream and gentle exfoliating, with her fingers, while showering, on the breast areas.
The psoriasis exacerbated on her breasts a few weeks post natal with her first baby 2 years ago and she persisted with breastfeeding, (condition un-diagnosed at the time), until resorting, due to painful breastfeeding, to fully expressing and bottling her reluctant baby, persisting for 10 wks until her supply significantly decreased.
Would you be happy to eloborate on your comments from Appendix E, P 1199 on the use of Elecon ung. or cream or any of the other preparations listed and varying strengths, that you feel maybe safer or recommended eg. Locoid etc. ?
This Mother is due to have an elective C/S in 2 wks time. Thank you for your time.
Regards Janette

[admin]

Janette:

Psoriasis is a difficult problem, certainly when it is on the areola or nipple. Psoriasis itself is difficult to treat, because it can become somewhat resistant to steroids over time. Thus dermatologists have all kinds of techniques to treat it, such as using high potency steroids, but only on Saturday and Sunday, and nothing the rest of the week. This is just one of many techniques.

I'd suggest she talk with a dermatologist, and avoid all HIGH potency steroids on the nipple, unless she washes them off thoroughly before breastfeeding. She can certainly use hydrocortisone, or mometasone (low to moderate potency) and continue to breastfeed. But she needs a consult with a dermatologist.

Tom Hale Ph.D.