If the rash appears with the MER (and fades in between?) it sounds like an allergic reaction to the oxytocin release.  Does she have any history with having looking particularly flushed and blotchy-pink after orgasms?   The lactating breast is full of oxytocin receptors, so if she is sensitive to the hormone, it may create a particularly localized reaction there. 

If she's not having anaphylactic symptoms -- headache and shortness of breath -- maybe she can hold off on the dermatologist/breast surgeon referrals.  She has a two-week old baby --actually only 36 weeks gestation now, plus an older child, so she doesn't need to be sitting in doctors' waiting rooms.  The current symptoms sound unpleasant, but not dire, so trying to reduce her stress level, helping her recover from a pre-term birth,  and buying some time may make the situation clearer.  The high hormonal state of the early weeks does moderate as lactation shifts from endocrine to autocrine control so sometimes these hormonally caused symptoms do improve as the body settles down.  She could try rubbing a topical anti-inflammatory on the affected area before feedings, or taking a non-sedating antihistamine.

Margaret Wills, IBCLC Maryland 

> 
> Date:    Tue, 15 Jan 2019 01:06:18 +0000
> From:    Allyson Michaels <[log in to unmask]>
> Subject: rash on the breast
> 
> I have permission to post. Second time mother, delivered two weeks ago, at
> 34 weeks. Infant being treated for suspected urinary tract infection with
> Ampicillin and Gentamycin. Several days ago, she developed a fine area of
> redness across the top of her right breast. She complained of itching with
> her let down with both breastfeeding and pumping. Her other breast is not
> affected, nor are the areola and nipple. She denied any change in laundry
> detergent, soaps, lotions, or the soap she uses to wash her pump parts. The
> area of redness is diffuse, not like an area of redness with engorgement or
> mastitis. It is not raised. It began 3 days after infant was started on
> antibiotics. Odd though, it is only with MER. I recommended she talk with
> her OB to start and that she may need to see breast surgeon or derm. I
> wondered about topical hydrocortisone.  She did not have this occur with
> her first child. Any thoughts?
> TIA,
> Allyson Michaels, MSN, RN, IBCLCCharlottesville, VA

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