“I have always been shapely with large breasts,” says Tina, a 62-year-old retired civil servant. “It runs in the family. Even when I was at my slimmest, I was a D cup. They never used to cause me problems, but about 20 years ago I noticed a red rash under my chest. It could be extremely sore and sometimes it would bleed. At night, I would want to hold my bust up because it was so painful.’
Tina was suffering from intertrigo, a condition that many women with large or sagging breasts have; yet it is rarely spoken about.”
The problem starts when the skin under the breasts rubs against them, causing irritation. Because the area is warm and moist, it is the perfect breeding ground for bacteria or yeast which are found naturally on the skin. These multiply, causing the rash to become infected.
“Intertrigo is a fungal, bacterial, or viral infection of broken skin. It is common among large-chested women as well as overweight people. Diabetes and stress can exacerbate the condition, which appears as a rash; wire from underwire bras would also dig in and aggravate the whole rash. The symptoms can be extremely painful and embarrassing, as the unsightly infection has an unpleasant odour.
Intertrigo is a fungal, bacterial or viral infection of broken skin. As well as large-chested women, it is a common problem among overweight or obese people, and can occur in other parts of the body such as the folds of the skin around the groin or buttocks, armpits, and even behind the ears.
‘Intertrigo becomes more common as cup sizes go up, but it is more to do with the shape of the breasts than the size; even someone with small breasts could suffer intertrigo if they sagged and rubbed the skin,” says Dr Graham Johnston, a consultant dermatologist at Leicester Royal Infirmary.
“It’s especially common as ladies get older and after they have had children. The breasts sag, and the skin thins with age, too, which means it is more sensitive. A badly fitting bra can cause the skin to chafe. The skin gets red and itchy because of all the sweatiness and chafing. But it is the growth of infection that causes real problems; this is from the normal bugs or yeast we have on our skin.”
Diabetes, a known risk for people who are overweight can further complicate intertrigo. Diabetes makes the skin more prone to infection because high blood sugar levels can weaken the immune system.
Big, overweight and large ladies, who fail to lose weight, could get into a vicious cycle of troublesome intertrigo that will never go away.’
Stress, which is known to exacerbate many skin conditions, can make it worse, adds Dr Anthony Bewley, consultant dermatologist at Barts Health NHS Trust in London.
“It can be very distressing. There is almost always a problem with people not coming forward due to embarrassment, because of the areas of the body that it concerns; and especially if it’s smelly.”
Good personal hygiene is key to preventing infection, explains Dr Johnston – unfortunately, while many people may be scrupulous about cleanliness, they are unwittingly doing the wrong thing.
“It is important to make sure the area remains clean and dry. I suspect a lot of ladies think they should be scrubbing and using creams on it, but ironically harsh soaps and cleaners can make it worse because they take away layers of skin, meaning the soap particles get trapped there and cause greater infection. So we recommend or prescribe a soap substitute such as an emollient.”
“Aqueous cream is a good soap substitute and should always be rinsed off, although it could sting during washing. Another life safer will be anti-fungal creams which can be bought over the counter, or if it’s really sore you need to see a doctor who might prescribe an anti-fungal with a bit of steroid in it to allow the skin to heal,” says Dr Johnston.
In the most severe cases, the skin can break and bleed, and those patients may need antibiotics.
Anyone suffering with this rash should consider seeing their doctor, because it may turn out not to be intertrigo, says Dr Johnston.
“Intertrigo can look almost identical to psoriasis which typically causes large, red, scaly patches on the skin – intertrigo is particularly close to flexural psoriasis which targets the folds of the skin under the breasts and buttocks.
“The key is to look at whether they have the rash elsewhere on the body, such as the nails and scalp that would suggest psoriasis.
“If you are small-chested but have a rash under your breasts, it is more likely to be something like psoriasis or an allergy.”
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