Hi everyone - I'm trying your collective wisdom in these few tricky
cases.
Recently I have seen three mothers with sore nipples which refuse to
clear up. In each case, they had been feeding pain free for months
before nipples became sore.
In each case, there was redness of the skin around the nipple, with
some dryness, and in one case, itching.
Thrush!! I thought. Easy, I thought.
Not so.
In each case, we have used all the usual thrush treatment, treated
baby, with no or little improvement. Gentian violet did help one
mother, but symptoms recurred within 48 hours. (gentian violet is not
easy to come by here - one mother had a real fight with the
pharmacist who was most reluctant to give it to her).
 There was
nothing to suggest allergy in any of the mothers, and none of them
were prone to dermatits, but as thrush treatment had been no help at
all, I tried treating them with a topical steroid ointment. It helped
a bit, but symptoms flared when we stopped. Not all babies were on
solids, and it didn't seem to be a reaction to solids in baby's
mouth.
 So what am I missing?  One mother had one nipple that healed,
but developed a yellow spot on the other nipple about 2mm across,
which refused to heal even when she pumped and didn't breastfeed for
5 days (not my suggestion, I add). She had also been using an
antifungal gel during this time. It is not a milk blister.

What is my next step?? All three are getting rather fed-up with the
slow progress being made, and the weeks of painful feeding.
Any suggestions?

Fiona


Fiona Coombes MBBS IBCLC               [log in to unmask]
Lactation Consultant, Family Physician
Perth Western Australia