I'm working with a mom whose baby is now 2 mos. She's gone through a number
of problems, including lots of nipple trauma early on. She had a couple
weeks of pain-free nursing, and now she has begun to develop "white spots"
that appear sporadically. By telephone I recommended saline soaks before
nursing and also gravity-aided nursing (mom over baby) once a day to help
clear whatever it was. What has happened is that they will clear and then
come back, one side and then another.

So, I saw mom this past week. What she had in that moment was one "coming to
the surface." You could see a vague white area below the epithelium, but it
was not a surface blister in that moment. Definitely not a solid
obstruction, and I'm not sure that it is a pore blockage, either. Once these
things come to the surface, she can eventually "rub" the overlying skin off,
and underneath will be pink. But, milk does not automatically come squirting
out, nor does she develop plugged ducts in the gland.

Baby had just developed a diaper rash when I saw her that was not responding
to desitin, and so I hypothesized that the blisters may be the more atypical
type sometimes associated with yeast. We trialed baby and mom both with
lotrimon, but in the next 48 hrs the rash got a little worse yet and nipples
remained the same. Mom took baby to ped for rash, who told her it wasn't
yeast and that it was caused by mixture of stools and urine in diaper. (this
is an exclusively breast fed baby) MD recommended neosporin (rash is rough,
raw, red) and desitin. So far (next 48 hrs), mom says diaper rash hasn't
improved yet. Nipples status quo.

Where would you go with this?

Lisa Marasco, IBCLC

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