Hi from New Zealand again.
A couple of days ago a mother came to me with Mastitis in both breasts. The
R breast was quite inflammed over half of it's area with evidence of a
blocked duct in at least one lobe. The L breast just had a patch of
inflammation but is quite soft. She had a fever of 39 degrees C.

Both nipples are quite damaged with a deep crack running across the centre.
Only the L one is painful.
I worked with her to clear the duct on the L side with baby suckling. This
was very painful for her so I switched to pumping.

 As we were pumping, a blister developed on the side of the nipple which
grew to a diameter of about a centimetre before we could turn the pump off.
The pump was on low, was not causing pain and was definitely centred. We
tried again with a better result, no blister forming and the duct seemed to
be drained.

She commenced antibiotics and elected to continue pumping on the L breast
while feeding on the R breast.

I saw her again today(2 days later) to get her breastfeeding going on the L
side The inflammation has gone but to my horror the L nipple has large scabs
all around as a result of blistering caused by the pumping. The areola is
like rice paper with a layer of skin peeled off.
Baby refused to suckle. I guess the feeling of the scabs must have been
quite unpleasant.

Mother has had psoriasis since the age of 8yrs with patches scattered
everywhere including on her chest. I wonder if this is the problem with her
nipple and areola.
What words of wisdom can you give me? I really value your input. I did
suggest hand expressing but the area around the areola is too tender and
still hardened from the mastitis. Is there a cream suitable or should she
see a dermatologist?
She won't be able to put up with much more.
The R nipple remains deeply cracked but painless.
Thanks in advance
Robyn Dunning
RGON,RM,IBCLC