I am seeing a mum  who has developed a recurring problem with a white/yellow
spot on her nipple that was causing pain on feeding her 7 month old.
Salicylic acid cream has been trialled but she was a little over-zealous and
the nipple became inflamed and sore. Kenacomb (a broad spectrum bacterial
and fungal cream) was used for a few days and it cleared. There has been
reoccurrence of this problem on both nipples a few times since. She has
tried clearing it with a sterile needle or expressing but it seems to
reoccur. On examination there was a tiny yellowish dot on the end of her
nipple which looked like a dried collection of milk in the duct opening.
Nipple otherwise normal. She could not express milk through this duct but it
appeared to temporarily clear with a feed when she could express a little
milk through it. Feeds are painful and she is considering weaning earlier
than she would have liked. There are no breast lumps or thickening
associated with the spot.

I suggested a sparing and careful trial with the salicylic acid cream for 2
days, to stop if any irritation occurred and said I would seek other
suggestions. Have suggested lecithin 1 tblspn/day, more polyunsaturated fats
and less saturated fats and more oily fish. Some suggestions from others
have been - thorough manual expression in case the duct is blocked further
back , while another suggested a galactocele might be a possibility.

Mum is Samoan and this problem only started after the baby was 6 months old.

Does anyone have any idea what is possibly going on and ideas to help this
mum?

TIA

Ruth Fiedler
Australian Breastfeeding Counsellor

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