Hi Fio,
You wrote of the lady with plugs and mastitis history that <<She also has 
oozy yellowish crusts on her nipples.  >> I am thinking this could be a 
double infection of bacteria and candida. Can this be cultured and/or send 
mother to a dermatologist? Has the abscess site been re-assesed lately, like 
by ultrasound? Paget's disease is a form of breast cancer presenting as you 
described, although I don't think it is usually painful and also is usually 
unilateral in its presentation. Hope you can get the diagnosis soon and 
treat appropriately. In the meantime, I would wash with mild soap and water 
and use something like Jack's all purpose cream which contains 
antibacterial, antifungal, and anti-inflammatory meds; but I would culture 
first. She likely would need systemic meds as well.

Laurie Wheeler, IBCLC, MN, RN

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