I have a mother with 4 month old baby girl. She has been exclusively pumping with a Pump In Style Advanced Traveler since day one (NOT my recommendation). For over 3 months she has had severe nipple pain bilaterally with pumping. She cannot stand anything to brush up against the nipples. She emailed me several times, refusing a consult. She was treated with Diflucan for several weeks and used Lotrimin topically with no improvement, except for a very little initially which she now thinks was just her *wanting* the treatment to work. She has seen a dermatologist who prescribed a steroid with no improvement. She has used lanolin. FINALLY, she agreed to come in and see me. I have never seen nipples look like this in over 9 years of practice. The entire nipple surface is covered with a yellowish-whitish covering. No signs of any cracks or fissures. Around the yellow, they are very red. No deep breast pain.

Due to the long-term treatment with Diflucan (a while back) and since she had seen a dermatologist (some time ago) I recommended salt water soaks several times a day with APNO applied after every pumping session. She also started a round of Keflex since the appearance of the nipples was pus-like in color although there was no obvious drainage. Normally, I would NOT recommend systemic antibiotic but with the duration of these symptoms, her treatment with an antifungal and a steroid, it seemed logical. She was told to pump on min suction. I have checked her nipple size with pump shield size and there is a good fit. The nipples are passing freely through the nipple tunnel of the breastshield.

She started the ABX and APNO Friday evening. Today I called to follow-up. While there is SOME noticeable difference in the amount of pain she experiences with pumping, the appearance of the nipples remains unchanged. 

Oh, I wish you could see them! What do you think this is?? Does she need to go back to the dermatologist? Go back to yeast treatment? Is this something so different that it's none of these? 

I should say that I saw her nipples a long time after her last pumping session so this was not vasospasm. They look like they are covered with huge blisters on the entire nipple surface and then directly behind this at the base is a very red, raw area--same on both sides. There does not seem to be fluid in the covering like a blister, however, and due to their size, they do not appear to be nipple blebs. They are yellow in color.

Thanks for your input!

Becky Flora-Waterman, IBCLC, RLC

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