This is perhaps going to sound foolish because you've probably been through most
of the options, but are her nipples and areolas moist and weepy?  One of the
worst cases of nipple thrush I've ever seen responded beautifully to plain
nystatin powder--dusted on after every feeding/pumping.  It really seemed to get
down into all the moist little crevices.  I couldn't believe nystatin worked
after all the other stuff that had been tried.  We had treated for about 6 weeks
with every topical known to exist; can't remember if we tried gentian violet
(assume you have) or systemics.

Becky Krumwiede, RN, IBCLC
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