A mom whose problems seem to be layered (hence my thinking of her as an
onion mom) had a baby born 10/9.

I first saw her at 6 days for extremely sore, scabbed nipples and what felt
like deep bruising from a clamping baby.  We worked on positioning, I got
her a pump to take some time off, and we tried to get her nipples healed.
She now pumps almost exclusively.  Baby is fully breastmilk-fed.

We've tried lansinoh, then she started on oral antibiotics because of a red
breast streak and breast pain, then topical nystatin, then oral diflucan
plus topical nystatin, then nystatin discontinued to see if it was the
*cause* of the continuing irritation, then cortisone and antibiotic creams
combined, then nystatin put back in the "nipple cocktail".

Baby has been to a chiropractor with craniosacral experience, because of
asymmetrical jaw and clamping.  That helped the pain some, but not a lot.
Mom can't afford to go back but is continuing the massages she was shown.
But even though baby's occasional nursings are still really painful and
nipple comes out somewhat creased, my guess is it's the nipples much more
than the baby that are causing such a high level of pain.  Pumping stings
initially, but becomes pretty comfortable.  I haven't been too interested
in possible remaining baby issues until we get her nipples fundamentally
comfortable.  Nursing with a shield didn't help significantly on the side
we tried it on.  We've done very little with non-standard positions, given
her discomfort.  Baby's chomping does seem to have decreased.  The mom
never expected not to breastfeed, is very comfortable with her own body,
cries when she thinks about this not working.

She's about to stop everything and try gentian violet (I know, I know, Dr.
Jack.  But better late than never) and is considering a dermatologist.
Prescriptions so far have been from midwife, who is as baffled as I am.

No history of allergies or sensitivities, but history of sexually
transmitted diseases (not HIV).  Thin cotton bra, no pads (we haven't tried
shells).  One nipple simply looks irritated, the other has circumferential
fissures that, while nice and clean-looking, just don't heal.  That side
produced globby milk (no breast lumps or milk blisters) until she started
lecithin.  Now the globs, at least, are gone.  She nurses once a day or
less, almost never on the fissured side.

Baby is thriving, has been treated with nystatin tho no symptoms.

I think we need to throw everything out and start over... but with what??
Just patience and time?  How long have you seen deep bruising and fissuring
take to heal?

Diane Wiessinger, MS, IBCLC, LLLL  fumbling in Ithaca, NY