My compliments to you, Christine.  You've done a nice job of presenting the
case, and it sounds as if you've done a lot of good background reading.
Just remember that nipple tissue is skin.  Like skin elsewhere on the body,
it can break down under stress.  The wet-dry stress of bfg, combined with
changes in saliva as babies teethe or begin solids, or as they get sick and
harbor viruses and bacteria, all can affect the mother's nipple skin --
particularly if it gets cracked.  Once the skin integrity is breached, there
may be all sorts of exposure to irritants, pathogens, etc.  Sometimes there
are allergic reactions to things moms do to try to treat the initial
problem.  Unfortunately, it's hard to tell just looking at them what is
going on.  And in my experience, women with bacterial infections, or with
eczema use words like "broken glass" or "burning, stabbing pain" as
frequently as do moms with yeast problems.  Going to a dermatologist can
help, as they have more expertise with skin, but often just doing a sort of
differential, rule-things-out type of approach can help.  She may want to
see if she can get her family doctor to prescribe Jack's triple action cream
and begin there.  If this doesn't help calm things down, 3 weeks of diflucan
with a loading dose would be worth a try.

Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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