Hygiene instruction vis a vis hand washing and laundry -- clean towels,
changing underwear, etc. are important during active fungal infection.  Many
of the handouts available (esp. Kay Hoover's nice one with pictures) stress
this.  I would like to share a strange case, however which points out how
yeast-phobia can contribute to a whole family's misery.

Asian mom, primip, baby 8 mo old.  Baby had thrush at 2 mo pp, successfully
treated with nystatin.  Mother had tender nipples at the time, and was
appropriately advised to treat aggressively with all measure of strenuous
hygiene including daily boiling of toys, teats, bras, etc.  She continued to
have slightly itchy, slightly tender nipples.  In spite of lack of sx that
fungal infection cont.she was urged by ph. to continue to treat for
"thrush".  She contacted her brother, a physician, who called in multiple
courses of diflucan for her.  She cont. the rigorous house cleaning and
boiling of clothing, sheets, towels daily.  Baby was painted with gentian
very frequently, cont. on nystatin.  This went on for MONTHS.  The feedback
she got over the ph. from all manner of counselors  was that she hadn't
treated vigorously enough or she wouldn't still be tender.

She finally saw a smart, breastfeeding friendly MD who told her she didn't
see any sign of fungal infection.  Mom was dubious, but agreed to come to
me.  Mother was hostile, and suspicious.  When I saw her and took a
throrough hx, I told her that I thought she needed to d/c all tx as it had
not worked in all this time, and to cont. might be causing or masking the
real problem.  Her response was "I might get worse."  Mine to that:  "Good,
then we'll have some real sx and can send you to a dermatologist for a real
dx."  As she was dressing, I noticed her putting tissue in bra over nipples.
I asked her if she always did that.  She said she always wore a tissue so
her "yeasty" nipples wouldn't contaminate her boiled bra.  I told her to
stop, that cotton was better than paper.

She phoned one week later to say all sx were gone.  The paper tissues on her
nipples had been provoking allergic response.  She remembered that during
preg. she had worn a brand of paper pads as she was leaking colostrum and
that had caused her to break out.  I think all the tx she was doing kept her
raw and irritated, and the tissues made it worse.

So please, lets not put people through the incredible aggrevation of having
to live like this by encouraging endless tx for "yeast" in the absence of a
real diagnosis. There are real risks from over-medicating and self-treating
-- esp. for the baby! And lets remember that allergic dermatitis acts a
whole lot like what some people think yeast infections do.
Barbara

Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html