Thanks to everyone for their responses. I have referred her to a dermatologist. I wanted to clarify that I observed her pumping with both her manual Avent Isis (she has the electric at home) and the Symphony I have here in the office. I do not think it is a flange fit issue. The discoloration is just at the edges of the crack, it is not the entire nipple like you see when moms are using too high suction. It gets very dark purple along the edges of the crack. I have never seen anything like it and I have seen some badly cracked nipples. I know that antibiotics can help with prolonged nipple cracks. She was on a course of antibiotics and she said there was no improvement. But it's possible it wasn't the correct type of antibiotics. I have told her I thing it would help if we could culture the crack. At any rate she is reluctant to do more meds. She is taking probiotics.

Andrea Tran RN, IBCLC
Boulder/Erie, Colorado


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