Hello-
I’m a long-time lurker and first time poster.  Quick intro: I have been a
volunteer breastfeeding counselor for seven years and IBCLC for one year in
private practice.  I have this mother‘s permission to post this case:
 This started in late July when child was about three months old.
The mother presented with a pea sized lesion on one areola.  It was itchy!
It grew to size of dime, then a quarter-- slightly raised and round.  No
bleeding but it oozed a clear yellowish liquid.  She saw a very experienced
LC at this time who had not seen it before.  After 10 days or so, it started
on other side with small spots.  In early August, mother saw her GP and then
a dermatologist, who called it “dermatitis”.  He prescribed Hytone
hydrocortisone ointment 2.5%  and oral dicloxacillin 250 mg, 4 times/day.
Mother says it sort of relieved some of the symptoms, but the skin got so
aggravated from washing the ointment off, the skin got “thin”.  She stopped
that treatment.  The symptoms got worse when the cortisone stopped-- the mom
thinks d/t anxiety and stress of the itching and discomfort.
 Some other points.  The lesions exactly match the boundary of the
baby’s mouth when he nurses.  There is no pain during a nursing, but the
pain and itching increase for about one hour after a nursing.  The poor
mother is going crazy with the itching.  She describes the lesions as
sometimes hard and crusty and sometimes soft and oozing.  One areola is
completely affected and the other about 75%.   She cannot tell if the nipple
itself is red or has lesions.  Everything itches.  She sometimes takes
antihistamine for itching.  Her OB and her dermatologist both don’t think it
looks like thrush.  I saw it in August and it didn’t look like “typical”
thrush to me either, but I know we can be fooled sometimes.  No other sx of
thrush in baby or mom or dad.  No deep breast pain.  About two weeks ago,
her OB researched some and thought it might be an allergy to something in
baby’s saliva.  For lack of another idea, she started her and baby on
nystatin to rule out thrush.  The OB has not recommended a culture because
it may not show anything conclusively, re: candida.   There has been some
small reduction in symptoms, but not much.  They still look awful- they
flare and bleed.  Mother is getting quite depressed and discouraged.  OB
suggested pumping and bottle feeding till it clears, but mother not willing.
 The thought of pumping makes her cry, as it would be so uncomfortable.
Other suggestion was to wean.  Mother has hx of allergy to cats, but no
other allergy or skin problems.
 Mother wants to know if there is another explanation or other
treatment, perhaps herbal or homeopathic.  She’s pretty desperate.
 My question.. if it is a bacterial infection, could it go on so long
without getting a lot worse?  Is this just run-of-the-mill thrush that’s
looks unusual and needs more aggressive treatment?  Could she be allergic to
baby’s saliva?
 We’ve also ruled out ringworm & herpes, we think.  Sorry this is so
long.  I wanted to add as many clues as I could.  Thanks for all your wisdom
and ideas.
Kitty Hunt, IBCLC
in glorious golden Gloucester, Mass.

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