Denise,

I think there's a good chance that the mom has yeast, and it's easy enough to
treat and see if she responds.  If not, then you go further.  I usually suggest
that mom can call her doctor, explain the situation, and request a prescription,
OR try Lotrimin AF which is available OTC.  Usually they just try the Lotrimin.
I suggest just rinsing the nipples with plain water after pumping or nursing,
pat them dry, apply the Lotrimin sparingly to the area that is sore, and rub it
in well.  After discussion with a pediatrician I trust, I don't tell the moms to
wash before feeding or pumping, but stress that she must not gob it on.  I think
it is important to use the cream after EVERY feeding or pumping, since yeast can
replicate so fast.  She should see a difference within a day of starting the
Lotrimin, and if none has been seen within 2-3 days, I'd go on to something
else.

If it does work, there have been other posts about how long to treat,
sterilizing pump parts, etc., so I won't rave on about that.  I see a lot of
presumed thrush, and much as I'd love to have somebody to refer out to, I don't.
The FP's expect me to tell them what to do or what to prescribe, and when I
tried to find a dermatologist to look at somebody, the best I could get was an
appointment in 3-4 weeks!  Big help!

Something that worked in one situation that had gone on for a very long time and
mom and baby had been treated with everything under the sun, was nystatin
powder, which I've not seen mentioned in our literature.  The mom's nipple and
areolar skin was so damaged that it was weepy.  She said the powder was helpful
at keeping everything dry, and probably got way down into the cracks.  She
healed in just a few days, after being treated with creams of various sorts for
over a month.  (Shells too, of course.)

Becky Krumwiede, RN, IBCLC
[log in to unmask]
[log in to unmask]