Dear Susan
as far as I am aware Daktarin gel is not ideal for using on nipples because
it may cause a dermatitis like rash which is probably what you observe. The
gel is intended for use on mucous membranes, not skin. Hence the gel can
dehydrate and irritate the skin. A better choice would be an ointment like
Nilstat or Mycostatin. The gel can still be used on the baby, but just keep
an eye on the mothers for signs of the rash returning. Or alternatively try
Nilstat drops or gentian violet for the baby, if you can get a hold of it
;-)

I guess Lansinoh too (*sparingly*) may relieve the rash by rehydrating the
skin. If that fails a mild steroid cream.
As to why only on the side the mother has fed on ??  I assume she stopped
using on the baby when she stopped using it on her nipples?

You do not mention why her nipples were treated so early (Day 3 from what I
understand). Was it 'just in case' because the baby had oral thrush and mum
had vaginal thrush? Or did she have the classic signs and symptoms? Did the
gel make any difference to her symptoms? When did the baby get oral thrush?

You say she has badly damaged nipples-is that now resolving? Often damaged
nipples give the same shooting pains and symptoms as you see with thrush so
I would want to work out what is what. If you think the nipple pain is from
trauma, then no you do not have to start the Nilstat again.

From what you say, I would suggest withholding all thrush treatment for now
and wait and see what transpires, after improving her positioning and latch
and eliminating other causes of traumatised nipples like tongue tie, high
palate etc.... So as to let things declare itself.

Here are some sites on nipple thrush I have collected that may help you:

http://www.hooverfam.net/kay/yeast.htm
http://www.breastfeedingonline.com/yeast.shtml
http://www.hooverfam.net/kay/candy.htm
http://www.mothering.com/12-0-0/html/12-2-0/12-2-bfthrush99.shtml
http://www.gp.org.au/cls/NIPPTHRU.html
http://www.breastfeedingnetwork.co.uk/information/thrush.html
http://www.leron-line.com/Thrush.htm
http://www.naturalfamilyonline.com/NH/20038-thrush.htm

hope this helps

Karen Clements
RM IBCLC Melb Aust

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