Karen said
> as far as I am aware Daktarin gel is not ideal for using on nipples
because
> it may cause a dermatitis like rash which is probably what you observe.
The
> gel is intended for use on mucous membranes, not skin. Hence the gel can
> dehydrate and irritate the skin.

Yes I think this is what has happened, it has been very very hot here, 38 to
43 degrees cent every day for the last fortnight.

A better choice would be an ointment like
> Nilstat or Mycostatin. The gel can still be used on the baby, but just
keep
> an eye on the mothers for signs of the rash returning. Or alternatively
try
> Nilstat drops or gentian violet for the baby, if you can get a hold of it
> ;-)

Nilstat ointment for mum and drops for the baby is usually what I see
prescribed here. As a new IBCLC in private practice who has come from a
non-medical background I will usually discuss the symptoms of thrush with a
mother and then refer them back to the primary care giver, usually their
general practitioner, for diagnosis and treatment.

> I guess Lansinoh too (*sparingly*) may relieve the rash by rehydrating the
> skin.
Yes, the mum is using this, not really sure it is re-hydrating but it is
providing some comfort.

 If that fails a mild steroid cream.
> As to why only on the side the mother has fed on ??  I assume she stopped
> using on the baby when she stopped using it on her nipples?

Yes she stopped using it on both at the same time. Prior to me seeing her
though she had been using it in baby's mouth, on both nipples *and* breasts
quite heavily. The rash only materialised on the side she was feeding on not
the side she had been expressing. Perhaps she was just more heavy handed
with appying the gel on one side?

>
> You do not mention why her nipples were treated so early (Day 3 from what
I
> understand). Was it 'just in case' because the baby had oral thrush and
mum
> had vaginal thrush? Or did she have the classic signs and symptoms? Did
the
> gel make any difference to her symptoms? When did the baby get oral
thrush?
>

Yes it was day 3, she was in hosp till early day 7 due to a large blood loss
postpartum and feeding difficulties.  From questioning the mum, and she was
very hazy as to exactly what day each event occured *as it was a blur* due
to her being unable to sleep for 72 hours until she was medicated.
From her recollection, by day 3 she had bad vaginal thrush, this has been
particularly painful due to extensive stitching. Nilstat ointment
prescribed, very successful.  Treatment continued till day 10 then stopped,
currently looks as if gone. Perhaps day four it was noted that baby's mouth
was *coated all over* with thrush so this is when the Daktarin gel was
prescribed for baby's mouth and her nipples.

Baby had one feed after birth then was on iv drip for first 24 hours no b/f,
then started at the breast on day 2, by early day 4 nipples were badly
fissued, by day 5 mum was feeding only one side and expressing other side.
From recollection she describes shooting pain when she fed which was blamed
on nipple thrush, however i believe this was more likely due to poor
attachment.
She was discharged early day 7 and then I first saw her later the same day.
This is when the rash was bad and the Daktarin ceased. Baby has no visible
signs at this stage and mum was in pain but had no visible signs of nipple
thrush.

As she was having difficulties with attachment we worked on that. She had
what she called her best feed yet, but still not optimal.  During the night
things went pear shaped and by morning both nipples were bleeding.
She expressed and cup fed for next 36 hours resting nipples. Then late day
10  we reintroduced the breast with nipple shield and she had two pain free
feeds, with good attachment. These were her first feeds with no pain. The
rash was greatly reduced.
At this stage she asked about restarting thrush treatment for her nipples
but with nilstat drops as the vaginal thrush had reappeared and she was
worried that only  3 1/2 days thrush treatment on the nipples was not enough
to eradicate it completely.

> You say she has badly damaged nipples-is that now resolving? Often damaged
> nipples give the same shooting pains and symptoms as you see with thrush
so
> I would want to work out what is what. If you think the nipple pain is
from
> trauma, then no you do not have to start the Nilstat again.

> From what you say, I would suggest withholding all thrush treatment for
now
> and wait and see what transpires, after improving her positioning and
latch
> and eliminating other causes of traumatised nipples like tongue tie, high
> palate etc.... So as to let things declare itself.

As I think the early shooting pain was attachment pain as opposed to thrush
pain then I  to think the wait and see is the best route.  Tongue and palate
all seem fine, I really think that the damaged nipples is primarliy a result
of the poor attachment during the first week of life.
>
> Here are some sites on nipple thrush I have collected that may help you:

This is great,
Thanks for your help Karen it has helped me clarigy my thoughts :-)
since last post mum  I have spoken by phone and mum is feeding with the
nipple shield on her good side and still expressing the bad side, but is
finding the vaginal thrush very troublesome.  She is worried the thrush will
*get in * through her still healing nipples.  We disscussed hygenie etc and
will monitor closely.

regards Susan

Susan Day IBCLC
breastfeeding counsellor with Australian Breastfeeding Assn
Mother to 5 daughters aged 13years to 20 months
Kalgoorlie, Western Australia

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html