Since moving to North Carolina, I have been seeing a great many women with
nipple yeast, sometimes in the hospital , and apparently the women have had it
during pregnancy.  Several times a week we see women with very sore, burning
nipples, many times complaining of shooting pains in the breast.  Most of the
time the babies are asymptomatic.  I havae just listened to the Yeast tape from
the ILCA conference by Kay Hoover, and gotten some ideas.
Lately more and more women are not responding to Nystatin , even with changing
bras, keeping the nipples dry, washing with hot soapy water, boiling pacifiers
if they use them,  etc.  This week I had two different women who responded great
for 2 days, and then all symptoms reappeared.  Should we suggest another topical
treatment if Nystatin doesn't work?  Lotrimin? What about oral medications?  I
know about Diflucan, but what dosage is recommended? For how many days?  Have
others had success with this?  I have a lot of questions.  Why is it so
prevalent here, and not so much in Georgia, a similar climate?  Does eliminating
sugar and fresh baked breads really help?  We need lots of suggestions because
every week we seem to be seeing more.  These are not latch on problems...We
evaluate for that.And  if they use the topicals, we usually have not told them
to remove them, but should we suggest cleansing the nipples with warm water
first before nursing?  And we always are sure that the babies are treated
simultaneously with Nystatin suspension.  Thanks for any help!
Ann M. Calandro, BSN,RNC, IBCLC