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.