In Medications and Mothers' Milk 2002, Thomas Hale addresses only intravaginal use of Terconazole.  He reports that "Even at high doses, the drug is not mutagenic... although no data is available on human milk..., and that milk levels are probably too small to be clinically relevant."   
    My question is if that mom was using another anti-fungal that gave relief and has a history of use for yeast on the nipple, why not go back to that one?   Sounds like this mom needs to see a dermatologist.  Switching PCPs just isn't always the answer.  Since MDs respect other MD opinions more than the LC opinions (usually) this could be an opportunity for mom's PCP to learn more about care in this situation.  A referral from the PCP usually results in a more easily obtained appt and a note of findings back to the PCP.   Also all that looks like yeast is not yeast.  Derms are the skin specialists and should be consulted when usual treatments aren't giving the usual response.  Also just as an FYI-- Kay Hoover wrote an excellent short article titled Candida Infections during Lactation that was presented as  a Practice Update in a publication from Lactation Education Resources.  I have faxed it to many MD offices usually with good results.  It's dated 1997 but the info is still current.  It may be available on LER's website (search Google) or mail me privately and I will fax a copy to you (permission was granted to reproduce the article.)
Amy Stallings  RNC, BSN, IBCLC (who wishes that teenagers didn't spend so much time on the computer, so that their mother could join lactnet discussions more frequently!)

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