A question from a pregnant mother in a breastfeeding class -- She has 
Severe Nodularcystic Acne, starting in sixth grade, across her body and 
arms, including her nipples and areola.  She describes having to "drain 
her bumps" or they get swollen and sore.  If allowed to get too big, 
they leave a real wound behind.

Her concern is not at all about whether breastfeeding will be painful 
for her, but whether the contents of the pustules would be harmful to 
the baby?  All the information I can find on acne and breastfeeding is 
about the occasional pimple on the nipple or  about medications, since 
it's unusual to have this kind of severe, ongoing acne in the nipple area.

She says she's now has insurance again and will be seeing a 
dermatologist, so I've asked her to ask about the contents of pimples, 
and whether it would be (while gross to think about) harmful to the baby 
to ingest orally.  I'm assuming that the pus is dead white-blood cells, 
lymph, skin oils.  But since we're always cautioned about squeezing 
pimples, since that spreads infection, is there actually active bacteria 
to contend with?  Is it a bug that would stand up to the digestive tract? 

I've said that my reasoning is that the risk of a small amount of 
exudate is minimal in comparison with a baby with perhaps a genetic 
predisposition to such a difficult chronic condition *not* to get his 
normal food and the support for a normal immune system.  But I would 
like to say something concrete to reassure her.

Since dermatologists don't tend have much education about breastfeeding, 
I also thought I'd ask here.  Could her condition possibly be a source 
of infection for a baby?

And while it's not strictly a breastfeeding issue (so feel free to send 
off-list), I'd love to be able to make some suggestions on improving 
such a difficult, long-standing condition.  I'm hoping the dermatologist 
has some ideas.  The mother said she had some luck with Accutane earlier 
on, but Hale rates that as L5.

Margaret Wills, IBCLC, Maryland

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