I totally agree.  Too many patients diagnosed with "yeast" when they really have a neuritis induced by a baby with a tongue-tie, high palate, exaggerated bite reflex, poor positioning, poor suck, etc.  We need to be able to do more nipple cultures for particluar organisms also for the perhaps rarer organisms also.  When there IS the visible sign of yeast as described below, it should respond to external medications.  If it doesn't respond - let's consider other possibilities.  I see too many patients self-diagnosing or having telephone diagnoses given with no direct observation of the problem!

-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Anne Eglash
Sent: Thursday, October 08, 2009 9:43 PM
Subject: KOH slides and yeast

I go against the grain when it comes to candida. My experience is that the vast majority of chronic breast pain is not simply yeast. I would only consider a diagnosis of yeast  if there is a convincing sort of nipple/areolar rash, much like the red rash seen in skin folds or vulvar areas when yeast is involved. Therefore, my recommendation is to do a KOH of the skin around the nipple/areolar area if you suspect yeast. I don't recommend doing this for milk, since yeast won't be found there, and if anything, untrained eyes might declare false positives. If you really want to try finding yeast in milk, do a milk culture.
Anne Eglash MD
Clinical Associate Professor
Dept of Family Medicine
University of Wisconsin School of Medicine and Public Health 600 N. 8th St.
Mount Horeb, WI, 53572
608-437-3064 (O)
608-437-4542 (fax)

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