PTP. A mom nurses first baby for 22 months, no issues, no nipple pain,
ever.  The baby developed a cold with congestion at 22 months, and had
difficulty nursing.  He was treated with motrin and benadryl, both of which
mom states he has had before. No other changes in his diet.  At the same
time, mom developed extremely sore nipples.  She lives an hour away but we
met and I looked at them... angry red and dry, not shiny.  Raised, puffy
plaque of irritation ending almost at the edge of the areola with very
clear borders... no satellite lesions. Crescent shaped cracks at the base
of each nipple with yellow crusting.  She said this developed almost
overnight.  No radiating pain into the breast, during or between feedings.
She saw the PA at her OB practice who prescribed Diflucan and an APNO
ointment with an anti fungal, cortisone, antibacterial, and analgesic
component.  After 2 weeks there was a small improvement and some healing of
the wounds, so the PA continued Diflucan for another week. Mom stated a 90%
improvement in how they felt and the healing of the cracks. As soon as she
stopped the Diflucan after this additional week, all symptoms returned
within 24 hours. My thoughts: Get a dermatologist to take a look, since it
seems confined to the skin and not throughout the breast. Mom made an
appointment for Monday.  Would more Diflucan make a difference?  Is there
something in the baby's diet that is causing an eczema or contact
dermatitis? Would an oral antibiotic help?
I would appreciate any thoughts.  Thanks!
Alison Keating RN, BSN, IBCLC, LLL
-- 
Alison Keating
3004 2nd Avenue
Altoona, PA 16602
814-946-7061
814-934-0466  cell

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