I have a client, 37 yo, primip. At 4 mos gestation the skin on her areolas began to peel causing her to lose the pigment on her areola. The area is not itchy but it is sensitive to touch. I have permission to post pics. She saw a local surgeon who ruled out breast cancer and told her it is due to hormones and would not get better and would cause her pain while she was breastfeeding. Baby is now 10 days old and she is using a nipple shield to cover the area as it is too painful to let baby's mouth on the area. She has tried APNO a couple of times but finds it painful to leave it on. Currently she finds having the area dry to be the most comfortable. After the feed and the Montgomery tubercles appear swollen. She says the area is more painful after a feed. Where the pigmentation is gone, there is a definite 'ridge' as though layers of skin have been taken off. I've asked for her NP to do a swab (apparently that's never been done) but I'm at a loss. Has anybody seen this before? I have pics but I'm not able to attach. I have permission to share as this mother is looking for information. Thanks, Karen Nielsen RN IBCLC Chatham, ON 

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