I had a mom with a 6mo call me today.  She complained of a "blister" that appeared 
about a week ago, that seems to have spread.  Not on her breast, just her areola.  They
are crusted and stick to her bra and peel off the skin.  Both sides now but the one with
the original "blister" is worse.  Again ONLY on her areola.  Things that have changed:
the baby has reflux and was on .5ml of Zantac 3x/day until about the same time the first
blister appeared when her dosage was upped to 1ml 3x/day.  Mom was administering it
just prior to the feeds hoping that if the baby spit up some of the Zantac would stay down.
My gut feeling is that somehow the pH or something to do with the medication is affecting
her skin as only the skin exposed to the baby's mouth is affected.  Can Zantac cause something
like this?  Mom doesn't have particularly dry or sensitive skin normally.  I suggested possibly
applying a coating of Lansinoh as a protective barrier but I'm not sure that is appropriate 
either.  I suggested she seek the opinion of a dermatologist but she wasn't too keen on 
that.  I also suggested she deliver the Zantac less close to feeding time and do some non-
medical interventions ( keeping baby upright etc.) for the reflux so that in combo the results may be the same. Has anyone seen this before? Does anyone know of a  breastfeeding friendly 
dermatologist in the Boston area?  Other suggestions?

P.S.  We don't think it's thrush (no antibiotic exposure, no burning / shooting pains, nothing in baby's mouth or diaper area), but I guess that is always possible too?  Would treating with gentian violet or a 
APNO cream be overkill?

Thanks,
Ilene Fabisch, IBCLC, RLC, LLLL

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