Regarding: the mother with nipple soreness which, presumably, started
recently.  The mother is also on antibiotics.

        Any new nipple pain that begins after a period of pain free nursing
should be considered as due to Candida until proved otherwise.  A milk
blister is another cause of new pain.  The fact that the mother is on
antibiotics may also be relevant, but not a necessary condition.  The
baby does not need thrush in the mouth, nor Candida rash in the diaper
area.

        Just on the basis of the information above (the characteristics of the
pain are not always helpful), I would treat with gentian violet 0.5-1%.
The mother should get rapid relief.  Quick scoop on use of gentian
violet.

1. Mother uncovers from waist up, baby undressed to diaper (gentian
violet is very messy).
2. Mother takes Q-tip and puts it into gentian violet, paints inside of
baby's mouth.
3. Baby goes to the breast, mother's nipple now treated, as well as
baby's mouth.
4. One such treatment for each breast once a day, so that if the mother
feeds on both at the feeding, it's done for the day.
5. 3 or 4 days of treatment all that is necessary.
6. If the pain is not gone after 3 or 4 days, question diagnosis, and do
not continue gentian violet.
7. Of course, the mother should be off her antibiotics when this is
done, but if she cannot go off right away, she can do the treatment then
repeat once off if necessary.  Still might work if she is on
antibiotics.

Jack Newman, MD, FRCPC