Dear Lactnetters,
Please, I need advise and help for a mother of a eight week infant.  Since
her antenatal period she displayed a problem with her nipples.  I referred
her to a dermatologist whom diagnosed eczema and prescribed a cortisone
mixture.  The nipples rapidly showed improvement and she hasn't used the
cortisone cream since then.  After the birth of her baby she went through a
stage were the little one was very fussy and displayed breast refusal, ?
because oral hyposensitivity.  Out of desperation the baby was fingerfed the
times that baby screamed and fought against the breast.  After about one
week of sometimes winning and latching baby, or fingerfeeding, baby
eventually latched without fighting mommy off.  When baby eventually latched
without protesting and starting to nurse her nipples showed trauma although
baby latched apparently correctly.  I must mention there is no sign of
ankyloglossia.  She has a very, very fair skin and her nipples are
hypopigmented.  She used only Lansinoh on her nipples and they eventually
healed with the help of laser therapy.  The last couple of weeks she is
constantly complaining of a pain in both breasts on the inferior side of
both breasts on the margin of the areola, but worse on the right breast.
Worst after feeding that gave the impression that it might be breast
candidiasis.  There were no signs of thrush in the baby's mouth or the pink
appearance of thrush on her nipples, but she was in any case treated with
Gentian Violet for three days.  She took Ibuprofen for the pain.  There were
no signs of mastitis, no induration or redness, no fever, no adenopathy.
There is also no palpable mass in the breasts.  About a week ago baby burped
some blood stained stomach contents and not knowing if it could be from the
breast or from the baby's gut, she expressed milk but the milk was clear of
blood. There was no apparent visual area on the nipples were the blood could
have come from. It was a once off incidence and baby did not burped blood
stained stomach contents again. In the meantime, because of the constant
pain in her breasts she was treated with Diflucan two days ago. There were
no signs of blood until today.  She phoned me to tell when baby came off her
right breast today blood was pouring from her nipple.  Her left breast is
feeling so much better after the Diflucan but her right breast is still very
painful.  I haven't seen her today to observe what the nipple is looking
like.  Could the cortisone cream that she used atrophied her skin so that
she could bleed so easily from the nipple even a couple of weeks after the
treatment, could it be because of her areola being so hypopigmentated, could
it be that baby has mechanically developed a wrong sucking method with the
initial fingerfeeding even if she is apparently latching correctly or could
the bleeding be from her breast?  How soon after the treatment with Diflucan
for breast candidiasis will a patient experience a reduction in pain?
Please give your opinions.
Thanks.
Yours sincerely,
Maureen Barnard. RN. Aspiring IBLCE candidate.
George. South Africa.

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