Janet, Did this mom have systemic, broad spectrum antibiotics associated with her knee surgery? The pain and fissure could be symptomatic of yeast. A mom with breast/nipple psoriasis may already have compromised skin defenses making her more susceptible to this opportunistic problem. If this is true then the triple atb cream would probably worsen the symptons. Probabilistically, it might be worth a try to self treat with an otc antifungal for 3 days, allow no nursing on this side but pump to avoid plugged ducts. If this improves symptoms, both she and her two year old should be treated. She should follow device and clothing care as if she does have a candida infection. Not easy for a mom confined to a chair, but then neither is distracting a persistant two year old. I know, I am also nursing one. Best regards, Glenda Deahl, RN,C P.S. Just took boards yesterday. :> Thanks to all the lactnet contributors. The discussions here were a big help in broadening my horizons.