Heidi,
Though from your description it surely sounds as if this mother has done
everything, I would go back and revisit the whole script one more time. What
kind of dosage was she on with fluconazole, and for how long?  JHL has
published a case report where the mom needed several weeks of therapy and a
low, long term dose (if I recall correctly) in order to keep things under
control. It surely is scary to think that she could have such a compromised
immune system.

My thoughts, without knowing the answers to the above questions, would be to
try her again on fluconazole, maybe 200mg for three or four weeks minimum.
Treat baby separately with fluconazole, and possibly family members also. I
would concurrently do a topical treatment--- gentian violet for mom's
nipples and baby's mouth might be a good choice. Lactnetter Becky Saenz MD
mixes gentian violet with zinc oxide "until it's the color of lavendar" and
applies it twice daily for the diaper rash. I do wonder if at this point a
steroidal cream may be needed too.

AND the light and the sun.

I've never thought of this before, but I wonder if there would be value in
having all of them take a soaking bath to which a little tea tree oil has
been added.

Please keep up posted.

Lisa Marasco, BA, IBCLC

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