Management of Idiopathic Granulomatous Mastitis: Effectiveness of a Steroid-Free Regimen Using -A Single-Institution Experience.

Idiopathic granulomatous mastitis (IGM) is a benign, chronic inflammatory disease with no effective treatment and high relapse rate. The pathophysiology is poorly understood. Tinosporin, an immunomodulator obtained from , is known to be useful in treating immune-mediated diseases. We report our experience of using Tinosporin for IGM and the effectiveness of this "steroid-free" regimen. We analysed the clinicopathological characteristics of patients diagnosed with IGM on histopathology during January 2018 and December 2022. Tinosporin tablet (500 mg Guduchi stem extract) was prescribed for 3-6 months; data were collected from electronic medical records and analysed in SPSS v-29. Of 315 patients, 132 had complete clinical records. Median age was 39 years (25-77), and 107 (81.7%) were premenopausal. Seventy-eight (59.09%) had clinical suspicion of malignancy. On imaging, 84 (63.64%) were BIRADS 4/5 lesions. Empirical broad-spectrum antibiotics were prescribed to 101 patients. Tinosporin tablets were prescribed to 91 patients. Symptomatic response was seen in 72 (79.12%). Five patients did not achieve response, while 14 patients (15.38%) were lost to follow-up. At a median follow-up of 36 months (14-62 months), only 2 patients on Tinosporin had recurrence. None of the patients needed surgical intervention other than diagnostic biopsy or control of infection, and none received steroids. IGM is a benign, often self-limiting disorder. However, it mimics malignancy in 60% cases, and histology clinches the diagnosis. We report the efficacy of steroid-free management of IGM with immunomodulatory herbal origin phytopharmaceutical drug Tinosporin. It is safe, inexpensive and effective. Large volume excisions or mastectomies can be reserved for severe and refractory cases.