Jan there is reference to exzema in an early Journal of Human Lactation.
Weeping Areolar Eczema and Eczema of the nipple/areola area. JHL 4(4), 1988.
p 166. I have dealt with this situation in my practise several times
although never with anyone who has gone so long undiagnosed.   Usually we
pick it up fairly early, thankfully. Perhaps because it is now a routine
question when a mom presents with sore nipples. (I too got caught thinking
the first time I saw it I was looking at yeast.  Fortunately I remembered
the JHL notes and corrected myself within the day.  It was a lesson that has
proven worth learning). My recommendations are partly derived from the JHL
notes and from LLL Canada Professional Liason files. They have been
effective but mom's need to work out their own combination of actions.
1. UV sunlamp two times a day, every day (watch for burning!)
2. B complex and Vit C taken orally
3. Only a white cotton bra or t-shirt
4. ointment used sparingly (hydrocortisone only if absolutely necessary)
applied onto dry nipples immediately after feeding so the cream is absorbed
before the next feeding. Do not stop use prematurely as you may have to do
it twice.  Continue until the symptoms have completely disappeared and for a
few days following.
5. wear breast shells to hold clothing away from the nipples if they become
painful and to increase air circulation. The M----a brand with the large air
holes work best.
6. when the infant starts solids clean their mouth just before nursing as
food residues may encourage a reaction.

      Unfortunately none of the information I have (maybe others are more
current?) suggests a replacement for cortisone. If general management does
not keep it under control, use the cortisone carefully until the symptoms
have completely disappeared, and a few days afterward so treatment does not
have to be repeated.
        With a young infant you might not be able to predict when the next
feeding would be, minutes? hours?  I wonder if, when lactation is
established, it would be possible to treat one nipple at a time especially
as many women nurse from one breast at a feeding.  This might increase the
likelihood of the cream being fully absorbed and reduce the risk to the
infant.  Does this make any sense?

        I apologize for the message going out from "steve". My computor whiz
14 yr old is absent and I can't figure out how to delete his name. Kathy D.
I have removed my signature until it is fixed and conforms to this system.
How's that for following orders. In my introduction yesterday I forgot (?)
to mention I am a mother of 3 teenaged boys all breastfed, including 2 fed
through pregnancy. I have B.A. in geography(resource management) from a VERY
long time ago. Was a LLL of Can. leader for 16 years,a few years as
Professional Liason, IBCLC for 9 years this summer, I am now in
semi-retirement. Too many family crisis and too much emotional involvement
with my work.  I REALLY cared whether those babes were fed! 6 months later I
am much healthier and happier.  Still teaching, but no more 24 hr on call.
After 16 years of constant phone calls my phone deserved a rest. So beware
the dreaded burn out. Especially those of you in private practise from your
home, give yourself a treat! you deserve it.

--Rhoda Taylor  e-mail [log in to unmask]