OK, wise ones.

The weather is hot and dry here on the plains...but moms are sweaty.  Having
several cases of yeast overgrowth...but one in particular has me stumped.

Mom presented in April with nipple and breast pain.  Her gyn nurse
practitioner prescribed Diflucan 150 mg po QD X 14 days.  We saw her on day
10, and her shooting pains had resolved, but nipples still diffusely tender.
APNO was added to the diflucan.  NP prescribed 4 more weeks of 150 mg/day
Diflucan.  Mom called us at the end to say her shooting pains were back, and
nipples constantly burning...worse when she was hot.  No blanching. I
suggested she take one 400 mg dose and add acidophilus and Grapefruitseed
extract. 10 days later the deep pain better, but nipples still burning.
Used gentian violet with only a small amount of relief.  At that point I
suggested she try a steroid ointment only on the nipples, hoping she was
eracting to a component of the APNO.  This did not help.  Talked to her
yesterday...she is unable to nurse because of the nipple pain.

My question is...has anyone seen Gentian Violet fail in a case of nipple
yeast?  My only other ideas are to try a different systemic antifungal
medication...but she doesn't have the deep pain anymore...and I don't really
expect it would be any better...or try Dr Gordan's methos of spraying the
GSE right on the nipples.

Any other suggestions???

Thanks-

Kathy Leeper, MD, IBCLC
Medical Director
MilkWorks, a nonprofit breastfeeding center providing consultations,
education, support and related supplies in Lincoln, NE

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