We have been finding that OTC preps such Lotrimon AF, Gyne-Lotrimon and Monistat work better than the standard Nystatin ointment on the nipples. If a mother is complaining of nipple pain that is consistent with yeast symptoms, but nothing in the breast, I recommend that she start with one of these, in conjunction with oral nystatin for the baby, boiling of pacifiers, pumps, bras, etc, and a change in diet. Generally speaking, if she applies a sparing amount thoroughly so that it is pretty much rubbed in and has disappeared, it will be absorped sufficiently by the next feeding as to be neglible in consumption for the baby. The mistake that is most often made is the cessation of treatment as soon as the symptoms abate; especially in the chronic cases, treatment may need to be continued for 1-3 weeks past the resolution time, preferably for both mother and baby. Cutting down on or eliminating yeasty foods, milk and sugar (both sucrose and fructose, including juices) for the duration seems to help, as does adding acidophilus supplements and possibly Yeastguard and garlic capsules. If she complains of shooting or burning pain in the breast as well, I am starting to lean towards sending her to her MD for diflucan as well sooner rather than later. Sometimes the inner pain can be alleviated without meds, but all too often she suffers for a long time, maybe even quits, while everyone argues over the merits of diflucan. There are two current theories regarding dosage: a 7-10 day dose, or a one shot megadose. I do not recall the exact amounts, but these two stategies seem to be par for the course, and I know that I have read somewhere (Oh where could that be?) about the efficacy of both treatments. Anybody else? I've been rather brief, but I hope that I have given enough to make sense. When working with yeast, I try to cover all the bases. Regarding the question of frequency: I don't necessarily have the answer for you, but I do see a higher frequency when lots of antibiotics are used prophylactically in late pregnancy and labor. Just recently I monitored a discussion on the ob/gyn listserv, and the docs themselves were discussing the rate of candidiasis as related to their specific therapies. Those who are conservative and aggressively treat for any possibility of infection (ie PROM, no apparent complications) see much more of this problem. I don't think they are even aware of the fall-out for nipple yeast, as so many aren't familiar with it and the mothers themselves often don't know what is going on, either. Could the regional differences be due to variations in regional practices with preg & antibiotics? This may be one important factor, along with those mentioned such as diet and weather conditions. Just a thought. -Lisa ****************************************************************************** Lisa A. Marasco, IBCLC / [log in to unmask] International Board Certified Lactation Consultant / [log in to unmask] ******************************************************************************