I have a mom returning to the States from the developing world next
month on annual holiday, who has no access to LC's where she's
located.

She has been suffering with what we believe has been recurrent
thrush for a year and a half, and has treated herself, baby, and her
husband with nystatin, and herself with other preps, including
fluconazole.  She initially presented with vaginal thrush, which
cleared up after treatment with isoconazole vaginal suppositories.
It moved to her nipples, and eventually yielded to treatment with
nystatin cream.  After surgery (atypical cervical cells, possibly
related to herpes, which may have been contracted in a not-too-
clean hospital where she delivered, since she and her husband
are strictly monogamous) and antibiotics, she presented with
reddened nipples, which are helped by nystatin cream, but Diflucan
"doesn't do anything".  Nipples are reddened, not cracked, and
hurt when nursing, not all the time.  (They hurt more if she stops
the nystatin cream.)  There is no evidence of the whitish spots
sometimes associated with thrush.

She uses L acidophilus and bifidus, and gives bifidus to the baby
(almost 3 now).  She has been unable to find gentian violet there.

I'm at my wit's end on this.  The only thing left in my arsenal is a
consult with a baby-friendly dermatologist, which I'm scheduling
for her, but I'd greatly appreciate any other suggestions you might
have.  I've thought of asking the dermatologist for diflucan (200mg
initial load, 100mg daily for 2 - 3 weeks for her, and mass-appropriate
dosage for baby), but the failure of the cream to give any relief makes
that questionable.  Itraconazole might be another choice, but she
won't have blood monitoring for posible hepatic toxicity when she
goes back.  My best guess is to ask the dermatologist to culture it,
and do a sensitivity study, but then she'll be going back by the time
she starts treatment.

Thanks in advance.

Jonathan

  Only G-d knows the formula for mother's milk

          L. Jonathan Kramer, P.E.
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       Graduate Breastfeeding Counselor
         Student Lactation Consultant
      Certified Medela Nursing Bra Fitter