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Nummular eczema a potential complication of breast reconstruction

Breast surgeons and plastic surgeons should recognize nummular eczema as a potential complication of breast reconstruction and guide patients on constant skin care with regular cleansing and moisturizers to prevent the condition.

Researchers reviewed 1,662 Japanese patients who underwent breast reconstruction between 2008 and 2013 at a single center in Tokyo.

Forty-eight of these women developed nummular eczema on the skin of the reconstructed breasts.

These patients were divided into three groups. Group 1 included patients that developed nummular eczema after tissue expander placement and before silicone implants were inserted.

Group 2 comprised patients that developed nummular eczema after implant placement and before reconstruction of the nipple-areola complex.

Group 3 was made up of those who developed the condition after reconstruction of the nipple-areola complex.

All women were treated with a Vaseline-based ointment containing 0.12% betamethasone valerate.

Out of 48 patients, only one had a comorbid condition of rheumatoid arthritis.

None of the patients had an underlying dermatological disease.

Tamoxifen citrate was used by 18 patients and two were taking anastrozole, according to researchers.

In most cases nummular eczema healed within 3 to 4 weeks with the administration of steroid ointments, such as betamethasone valerate.

Nummular eczema did not deteriorate further to cause ulceration or chronic infection.

Nummular eczema is, “recognized as a multifactorial clinicomorphological entity, not an independent disease,” the researchers wrote.

All patients healed using steroid ointments without removing any silicone implant.

The researchers found it unlikely that nummular eczema was caused by immunological response.

They speculate that nummular eczema is induced by structural changes in the skin due to surgery. Subdermal fat may also be an influential factor. Where patients’ fat layers are thin, the blood supply to the breast may be significantly reduced as expansion proceeds.

In some patients the condition can require 6 months to heal. – by Abigail Sutton

Disclosure: Part of this study was supported by Grants-in-Aid for Scientific Research Fund (C-15K01292) provided by the Ministry of Education, Science and Culture of the Japanese Government. The researchers reported no additional relevant financial disclosures.