Table 3.

Practical application of treatment modalities in idiopathic granulomatous mastitis

Treatment modalities	Proposed treatment approach
Topical steroid therapy [11, 23]	Prednisolone 0.125% pomade is applied twice daily to the affected breast, with a stretch film for at least 1 h to enhance absorption
	Patients receive initial instructions at the hospital and self-administer treatment at home. The pomade is used on weekdays, with weekend breaks (1-week cycle), and continued until a complete clinical response is achieved
ILS therapy [8, 14, 24–26]	40 mg of methylprednisolone is injected per lesion, with a maximum total dose of 100 mg for multiple lesions. Aspiration is performed if a collection is present
	Injections are given monthly, with a 2-week interval if symptoms worsen. Treatment ranges from 2 to 8 sessions, averaging four
	This protocol can be combined with topical steroids to optimize efficacy
Oral steroid therapy [11, 27–29]	Methylprednisolone (0.5–0.8 mg/kg/day) is given once daily in the morning after meals, with gradual tapering based on clinical and radiological response
	When combined with topical steroids, a lower starting dose (e.g., 0.4 mg/kg/day) may be used while maintaining a gradual tapering approach
	Precaution: restrict salt and sugar intake, monitor for iatrogenic Cushing’s syndrome, and limit treatment to 6 months to minimize complications
MTX therapy [3, 22, 30–32]	Dosing: 5–15 mg/week (PO), increased to 20–25 mg/week if needed, for 6–24 months
	Administration: oral MTX is preferred; switch to SC MTX (12.5–15 mg/week) if intolerable (GI side effects, relapse, or prior failure)
	Supportive therapy: 10 mg/week folic acid; contraception required for women of reproductive age
	Monitoring: CBC and LFTs every 2–4 weeks, with monthly evaluations for efficacy and safety
	Precautions: monitor hepatic, renal, and bone marrow toxicity. Consider azathioprine (AZA) if intolerance or inadequate response occurs

ILS, intralesional/intraparenchymal steroid; MTX, methotrexate; PO, oral; SC, subcutaneous; GI, gastrointestinal; CBC, complete blood count; LFTs, liver function tests; AZA, azathioprine.