Diane K. asks about woman with sore, cracked, bleeding nipples; 6 month old
baby; doctor prescribed steroid ointment (Elocon) for nipples.
This could be eczema or it could be thrush....
With a 6 month old baby, I have seen mothers develop eczema following the
introduction of solids (eg rice cereal) in the baby's diet. The nipples
would be very red, possibly flaky and itchy, with a definite edge to the
rash. The nipples would already be improving with a topical steroid.
If it was thrush, the nipples would not be so inflamed. Often thrush cannot
be found elsewhere. The nipple pain would probably be somewhat improved with
the steroid, but would need antifungal treatment too.
I agree with Tom Hale, the steroid doesn't have to be washed off if it is
used very sparingly after feeds, and not continued longer than ten days.
[See my case report in Journal of Human Lactation, September 1993, 9(3):
173-175]
Good luck,
Lisa Amir
GP/LC, Melbourne, Australia