{"id":547161,"date":"2026-06-21T19:31:17","date_gmt":"2026-06-21T19:31:17","guid":{"rendered":"https:\/\/www.europesays.com\/ie\/547161\/"},"modified":"2026-06-21T19:31:17","modified_gmt":"2026-06-21T19:31:17","slug":"breast-skin-diseases-in-gender-diverse-patients-what-every-dermatologist-needs-to-know","status":"publish","type":"post","link":"https:\/\/www.europesays.com\/ie\/547161\/","title":{"rendered":"Breast Skin Diseases in Gender-Diverse Patients: What Every Dermatologist Needs to Know"},"content":{"rendered":"

By Nikkia Zarabian, BS,\u00a0and Mina Farah, BA<\/strong><\/p>\n

Expanding dermatologists\u2019 knowledge of breast, nipple, and areolar (BNA) skin disease in gender-diverse patients is an important step toward more inclusive and effective care, said Emily Nadelmann, MD, FAAD, Assistant Professor of Dermatology at The George Washington University School of Medicine and Health Sciences and the University of Maryland School of Medicine in Baltimore, MD, at the inaugural 2026 From Evidence to Equity (FETE) Conference in Washington, DC.<\/p>\n

Dermatologists frequently serve as the only healthcare practitioners routinely examining the skin, placing them in a unique position to identify breast and chest pathology. However, nearly half of US dermatology residency programs report no formal sexual and gender minority (SGM) populations-specific education, and SGM patients with skin disease are significantly more likely to report not being treated respectfully by healthcare practitioners.1,2\u00a0In addition, breast cancer screening rates remain low among transgender populations, despite the presence of residual breast tissue and documented cases of incidental malignancies identified during gender-affirming surgery.3<\/p>\n

Performing Inclusive Breast and Chest Examinations<\/strong><\/p>\n

Dr. Nadelmann encouraged clinicians to use patient-preferred terminology, ask permission before binder removal, and document anatomy present rather than assuming anatomy based on gender identity. Using terms such as \u201cchest skin examination\u201d instead of \u201cbreast exam\u201d may improve patient comfort while facilitating comprehensive evaluation.<\/p>\n

Diagnosing and Treating Inflammatory and Infectious Breast Skin Disease<\/strong><\/p>\n

A practical disease-classification framework can guide diagnosis and management of BNA disorders. Common inflammatory conditions include atopic dermatitis, irritant contact dermatitis, allergic contact dermatitis, psoriasis, lichen planus, and hidradenitis suppurativa.4\u00a0Several conditions may be uniquely influenced by gender-affirming practices. Dr. Nadelmann also highlighted granulomatous mastitis (GM), the most common benign mimic of inflammatory breast cancer.4<\/p>\n

Neoplastic Disease and the \u201cMust Not Miss\u201d Triad<\/strong><\/p>\n

Because clinical-pathologic discordance is common in nipple and areolar lesions, Dr. Nadelmann advocated for a low threshold to biopsy unilateral, persistent, or treatment-resistant lesions. She emphasized three diagnoses that dermatologists must not overlook:<\/p>\n

    \n
  1. Paget disease of the breast typically presents as a unilateral eczematous lesion that fails to improve with topical corticosteroids. Most cases are associated with underlying breast carcinoma.5<\/li>\n
  2. Inflammatory breast cancer (IBC) often presents with rapid-onset erythema, skin thickening, and peau d\u2019orange. Importantly, a benign skin punch biopsy does not exclude IBC, which remains a clinical diagnosis.6\n<\/li>\n
  3. Radiation-induced angiosarcoma (RIAS) presents around 7\u201310 years after breast radiation therapy as violaceous patches or plaques within the radiation field. Molecular testing for MYC amplification can help distinguish RIAS from benign vascular proliferations.7<\/li>\n<\/ol>\n

    Dermatologic Effects of Gender-affirming Care<\/strong><\/p>\n

    Gender-affirming practices introduce additional diagnostic considerations for dermatologists.<\/p>\n

    Chest binding, which is defined as the compression of chest tissue for gender congruence,8\u00a0can be associated with a high prevalence of dermatologic complications, including irritation, hyperpigmentation, scarring, folliculitis, intertrigo, and skin breakdown.8\u00a0Patients should be counseled to choose breathable materials and avoid tape or Ace Bandages.8<\/p>\n

    Testosterone therapy is associated with increased sebum production, acne, terminal hair growth, androgenetic alopecia, and progressive lobular breast atrophy.9\u00a0Estrogen-based hormone therapy promotes the development of breast ducts, lobules, and acini.9\u00a0Reduced sebum production may also be observed in patients receiving estrogen-based therapies, which may contribute to xerosis and eczema as breast tissue develops.9<\/p>\n

    Hypertrophic scarring is a common complication following gender-affirming mastectomy.10\u00a0Risk factors include perioperative androgen exposure and non-White race.10\u00a0Intralesional corticosteroids with or without 5-fluorouracil, pulsed-dye laser therapy, and silicone sheeting remain important treatment options.10<\/p>\n

    Dr. Nadelmann also discussed complications of unregulated silicone injections used for chest feminization. Migration, chronic inflammation, granuloma formation, infection, and atypical mycobacterial disease are common.11<\/p>\n

    Breast Cancer Screening Considerations in SGM Patients<\/strong><\/p>\n

    Breast cancer screening should be individualized based on tissue present, hormonal exposure, and surgical history rather than gender identity alone.11\u00a0Transfeminine patients receiving long-term estrogen therapy (\u22655 years)\u00a0may require routine mammographic screening starting at the age of 40 according to current guidelines.12\u00a0Transmasculine patients without chest surgery should generally follow standard breast cancer screening recommendations.12<\/p>\n

    Dermatologists may be the first clinicians to recognize suspicious breast or chest skin findings. Maintaining a broad differential, performing inclusive examinations, and understanding the dermatologic implications of gender-affirming care are essential to improving outcomes in this patient population, Dr. Nadelmann said.<\/p>\n

    ABOUT THE AUTHORS:<\/strong><\/p>\n

    Mina Farah, BA,\u00a0and Nikkia Zarabian, BS, are Dermatology Research fellows at the George Washington University School of Medicine and Health Sciences in Washington, DC.<\/p>\n

    REFERENCES:<\/strong><\/p>\n

      \n
    1. Jia JL, Nord KM, Sarin KY, Linos E, Bailey EE. Sexual and gender minority curricula within US dermatology residency programs.\u00a0JAMA Dermatol. 2020;156(5):593\u2013594.\u00a0https:\/\/doi.org\/10.1001\/jamadermatol.2020.0113<\/a><\/li>\n
    2. Nock MR, Kamal K, Zampella JG, Roberson ML, Cohen JM, Barbieri JS. Barriers to care among sexual and gender minority individuals with chronic inflammatory skin diseases in the US.\u00a0JAMA Dermatol.\u00a02023;159(12):1323\u20131331.\u00a0https:\/\/doi.org\/10.1001\/jamadermatol.2023.3328<\/a><\/li>\n
    3. Kiran T, Davie S, Singh D, et al. Cancer screening rates among transgender adults: Cross-sectional analysis of primary care data.\u00a0Can Fam Physician. 2019;65(1):e30\u2013e37.\u00a0https:\/\/pubmed.ncbi.nlm.nih.gov\/30674526\/<\/a><\/li>\n
    4. Waldman RA, Finch J, Grant-Kels JM, Whitaker-Worth D. Skin diseases of the breast and nipple: Inflammatory and infectious diseases.\u00a0J Am Acad Dermatol. 2019;80(6):1483\u20131494.\u00a0https:\/\/doi.org\/10.1016\/j.jaad.2018.08.067<\/a><\/li>\n
    5. Zengin HB, Tan PH, Liu R, Smoller BR. \u201cEczematous\u201d dermatitis of the nipple: Clinical and histopathological differential diagnosis of Paget disease.\u00a0Pathology. 2024;56(3):300\u2013312.\u00a0https:\/\/doi.org\/10.1016\/j.pathol.2023.10.018<\/a><\/li>\n
    6. Robertson FM, Bondy M, Yang W, et al. Inflammatory breast cancer: The disease, the biology, the treatment.\u00a0CA Cancer J Clin.2010;60(6):351\u2013375.\u00a0https:\/\/doi.org\/10.3322\/caac.20082<\/a><\/li>\n
    7. Rao J, DeKoven JG, Beatty JD, Jones G. Cutaneous angiosarcoma as a delayed complication of radiation therapy for carcinoma of the breast.\u00a0J Am Acad Dermatol.2003;49(3):532\u2013538.\u00a0https:\/\/doi.org\/10.1067\/s0190-9622(03)00428-6<\/a><\/li>\n
    8. Peitzmeier S, Gardner I, Weinand J, Corbet A, Acevedo K. Health impact of chest binding among transgender adults: a community-engaged, cross-sectional study.\u00a0Cult Health Sex.2017;19(1):64\u201375.\u00a0https:\/\/doi.org\/10.1080\/13691058.2016.1191675<\/a><\/li>\n
    9. Goldstein Z, Krasowski MD, Greene DN. Gender-affirming feminizing hormone therapy.\u00a0JAMA Intern Med.2025;185(8):1027\u20131028.\u00a0https:\/\/doi.org\/10.1001\/jamainternmed.2025.1161<\/a><\/li>\n
    10. Rutnin S, Yongpisarn T, Sakpuwadol N, et al. Efficacy and safety of 1064-nm fractional picosecond laser for the treatment of postmastectomy scars in transgender men: A randomized controlled trial.Lasers Surg Med. 2024;56(4):337\u2013345.\u00a0https:\/\/doi.org\/10.1002\/lsm.23775<\/a><\/li>\n
    11. Cordero DM, Srinivasa D, Barnes LL, Ray E, Terry MJ. Surgical treatment of granulomatous breast deformities caused by injection of foreign substances in transgender women: A case series and algorithm.\u00a0Plast Reconstr Surg.2022;149(6):1312\u20131316.\u00a0https:\/\/doi.org\/10.1097\/PRS.0000000000009092<\/a><\/li>\n
    12. ACR appropriateness criteria\u00ae. Transgender breast cancer screening. Reston, VA: American College of Radiology; 2021. Accessed June 14, 2026.\u00a0https:\/\/acsearch.acr.org\/list\/TopicNarrativePdf?topicId=283<\/a><\/li>\n<\/ol>\n


      \n \"Print
      \n <\/a><\/p>\n","protected":false},"excerpt":{"rendered":"By Nikkia Zarabian, BS,\u00a0and Mina Farah, BA Expanding dermatologists\u2019 knowledge of breast, nipple, and areolar (BNA) skin disease…\n","protected":false},"author":2,"featured_media":547162,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":"","_share_on_mastodon":"0"},"categories":[78],"tags":[59081,18,234628,135,19,17],"class_list":["post-547161","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health","tag-breast","tag-eire","tag-gender-diverse-patients","tag-health","tag-ie","tag-ireland"],"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@ie\/116789765639243575","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/posts\/547161","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/comments?post=547161"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/posts\/547161\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/media\/547162"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/media?parent=547161"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/categories?post=547161"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/tags?post=547161"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}