Hi Jennifer,
I would be very cautious in continuing use of the APNO in this case, as the 
dermatologist believes she is having an allergic reaction to something. Allergic 
reactions can convert very suddenly from a mild contact dermatitis to a life 
threatening anaphylaxis, if exposure to the allergen continues.

Before continuing it might be prudent to send her to an allergist for allergy 
testing. If as you say her nipples are improving with pumping, then maybe if 
the baby is left completely off the breast they will heal on their own. If that 
does not happen, if she is allergy tested, a safe medication could be 
recommended. I had one mom with a persistent case of yeast tell me that 
nothing worked until she went naked sunbathing in Florida (she was a New 
Yorker). I am begining to wonder if we should be recommending a trip or two 
to the tanning parlor for our "yeast mommies"

One other thing - your description of the blisters on the nipples, and then a 
spreading rash, makes me wonder about impetigo. Has anyone considered this?

Kathy Lilleskov RN IBCLC

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