Hi. I would be very grateful for any suggestions on this lady. I saw her in
early March ( she delivered 9th. Feb.99)  by which time she had already had
one course of antibiotics for mastitis of the right breast and she was also
being treated for suspected thrush. Her baby was not attaching well -
sucking in lower lip, & taking in insufficient breast tissue. She was
assisted to improve positioning & attachment, but was very reluctant to
hold baby in any position other than cradle hold and baby was not attaching
well in this position.
After feeding & apparently also on nipple stimulation the tips of her
nipples become dark yellow & she has a burning sensation. Since I saw her
she has had a further course of antibiotics for UTI & she continued with
treatment for fungal infection for about 2 weeks.
She was seen by a GP who swabbed her nipples. Lab reports are negative but
she doesn't know whether they were looking for fungal or bacterial
infection & the swab was also inadvertantly labelled as a vaginal swab!!!
Yesterday she saw a consultant dermatologist who felt that there was a
bacterial infection in her nipples. He prescribed a topical treatment
consisting of one third strength flucinolone & econazole & advised her to
clean her nipples with saline & then with Lactawash(I am not familiar with
this product) before breastfeeding.. She then proceeded to consult her
pardiatrician who felt bacterial infection was unlikely & suggested she
also contact me. So far she has not used the treatment & this morning I had
to persuade her not to consult a further dermatologist as I feel so many
opinions may confuse her further. She appears still to have attachment
problems as she describes the nipples as slightly flattened after feeds but
she is reluctant to bring the baby in & so it is difficult to advise her
further. She also has a blocked duct/ milk plug on her Lt nipple.
I would appreciate some words of wisdom. Does it sound like a persistent
fungal infection? What is the cause of the yellow colouration of the
nipples. I am unable to find much information on this in the literature.
Incidentally, this is her third baby. The other two were both breastfed but
she did experience nipple pain for the first month with the second baby.
Thanks for your help.
Best wishes,
Christine Choong in Kuala Lumpur