I could use some input on this mom.  This mom is suffering from such a
confusing assortment of symptoms, that I'm not even sure where to begin
explaining her situation.  Bear in mind that this is a WIC mom (Women,
Infants, and Children - a program for poor and moderately-low-income women
in the U.S) - she speaks only Spanish,
has little money, little to no help at home, and no health insurance.

This is mom's first baby; baby is now 15 days old.  Throughout most of her
pregnancy, my client had what she calls a rash on her breasts, stomach and
upper thighs.  It went away 1 week prior to the birth of her baby, then
returned after birth, though this time not on her legs.  When I saw her two
days ago, she said she was getting better.  The stretch marks on her lower
abdomen were a deep red, and were quite pronounced.  Her breasts were an
even red, all over.  NOT the nipple, areola, or I'd say a good 2 inches
around the areola, but from that point outwards, both breasts were red - not
as dark as the stretch marks.  The redness extended all the way up to her
clavicles.  I would have thought that she had  a severe case of mastitis,
but she has no other symptoms of mastitis - no fever, no bodily aches/pains,
etc.  Walking and talking like a woman who felt fairly well.  Her breasts
were quite full, warm to the touch, and somewhat lumpy, but that was from
not nursing.  She had stopped temporarily due to fear of nursing with the
cream she had been putting on her breasts.

What cream, you ask?  triamcinolone acetonide (aka Nasacort).  During her
pregnancy she applied a lot of Vitamin E cream ("all over", she said), and
was still using that as well.  She got the triamcinolone from the local
public hospital's ER, where she went to get help with the rash.  They also
gave her Benadryl, which she stopped taking since it wasn't working, she
said.  I advised her to stop the Vitamin E.  According to her the
triamcinolone is not helping either.

She reports itchiness, plus a burning pain in her breasts and nipples,
throughout the feedings and afterwards.  The pain is severe.  Prior to
calling our office her nipples were cracked, but were well healed by the
time I saw her.  When she arrived basically without an appointment, to see
me, I was in the middle of teaching a class, so I did not get a real good
look at her nursing, but I saw enough to notice that her nipple blanched
when the baby let go.  Large nipple; I could see where possibly the baby
could hurt her if he didn't open wide enough, but the latch looked good to
me at first glance.

On the phone today I asked her about the blanching, and she confirmed that
yes, her nipples blanch whenever the baby lets go of the breasts.  She has
noticed that herself and has always wondered about it.  Sometimes she feels
severe pain in her breasts even when not nursing, such as when she removes
her bra, but the blanching only occurs when baby lets go of the breast.

When we parted after the consult 2 days ago, she was to see a doctor at the
clinic where the WIC office is located.  I thought she could use a 2nd
medical opinion.  She told me on the phone today that they don't know what's
wrong with her, that they told her not to worry about it since the baby is
healthy, to continue using the triamcinolone cream, but not the Benadryl
(since she's nursing and therefore "can't", they told her).

So, I've got a case here where even the doctors don't know what to do.  I'm
inclined to say that I'm seeing, possibly, a case of Raynaud's Syndrome, but
that wouldn't explain the rash.  Could the Vitamin E be the additional
culprit there?  Any and all suggestions would be appreciated!

Sorry for the long explanation, but if you've made it thus far, you
understand that it was necessary :-)
Regina Roig-Lane, BS IBCLC, stumped at WIC in Miami-Dade County


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