EpistemisGalactophoritis
Specialty: Gynecology and breast.
Why it occurs
- Chronic obstruction of a milk duct with accumulation of cellular debris and retained secretions
- Low-grade ascending bacterial infection due to skin flora (Staphylococcus epidermidis or Streptococcus spp.)
- Chronic smoking (cause of recurrent squamous ductal metaplasia that promotes inflammation)
- Prolonged use of breast pumps with inadequate traction on the areola
Initial workup
High-resolution directed breast ultrasound to assess the caliber and content of the dilated milk ducts (search for debris or thickened walls) and rule out hidden collections or abscesses. Culture of the secretion obtained by gently expressing the affected pore to guide specific antibiotic therapy. Mammography after resolution of the acute inflammatory process in women at risk.
red flags
Appearance of skin erythema surrounding the areola with fever of 38ºC or higher, formation of a periareolar skin fistula through which pus or fetid secretion drains, persistent acute retraction of the nipple, axillary lymphadenopathy of hard consistency, retroareolar induration that does not decrease with emptying of the breast.
Standard management
- Amoxicillin/clavulanic acid 875/125 mg orally every 8 hours for 10-14 days
- Clindamycin 300 mg orally every 8 hours for 10 days in patients allergic to penicillins
- Ibuprofen 600 mg orally every 8 hours as a systemic anti-inflammatory
- Local warm compresses applied before performing a very gentle expression of the inflamed ducts to facilitate drainage (note: avoid drastic cessation of breastfeeding if present, recommending frequent complete emptying).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Gynecology and breast
- Listed causes
- 4
- Treatment options
- 4