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Thursday, April 17, 2014
Painful cracked dry skin on nipple and areola
I am breast feeding an 8 month old. I have been pumping for 5 months but 2 weeks ago my nipples got abraded with a strong hospital grade pump and the meleda inserts that are about 1.5" in diameter.
A crack formed at the base of my nipple. I applied lanilon after each nursing for several days. I tried pumping again and drew blood in 30 seconds. After 5 days my areola became red, painful and puffy. Then the skin started cracking and peeling and looking like eczema (a resident physician at the clinic I delivered at said this). I had also tried neosporin about 3 days after the lanilon on the bleeding cracks. I believe that I am experiencing an alergic reaction to the lanolin or neosporin. I think it is the lanolin because the irritation spread before the neosproin. For the last 5 days I have applied nothing. 4 days ago I went to a doctor and lactation consultant and they were basically stumped. The Dr. said that it didn`t look like a bacterial infection.
I bought new softer attachments for my breast pump. The also drew blood on the lowest setting and I didn`t even get any milk. I have given up on pumping.
I don`t know what to do. My skin is not clearing up and now I have 2 cracks on my right nipple at the base and just above the base and the skin is still flaky and green (but not oozing)in a 1.5" diameter ring of the areola. When the skin flakes off it is shinny underneath.
I had another OB appointment Wed for a different reason and she did a culture of the skin for yeast. I haven`t heard back and I think that means it was negative.
I wanted to Breast Feed until 12 months but it is very painful and I see no relief in sight. I believe my next move should probably be to a dermatologist but I would have to see my primary care physician and then get a referral and this process has taken several weeks in the past.
Do you have any ideas? I tried olive oil this evening. Now I`m afraid to try anything because it may make it worse.
The doctor Monday did pretty much say that if I quit irritating the skin (i.e. quit brestfeeding) that it would heal.
Is there any chance of this healing while I continue to BFd? How long should I go before I give up? Will this condition cause permanent damage to my areola skin?
When it comes to breakdown of nipple and areolar skin, it really has to be seen and often cultured to make any kind of clinical judgement. I will share some thoughts based on what you describe, but please realize it is only a "guesstimate" since I cannot see you.
The skin condition you describe, including the pain with breastfeeding, sounds like nipple/areolar skin affected by a bacterial or yeast (candida) infection--or a combination of bacteria and yeast, which is fairly common. You mentioned that a culture for candida was done, but was one also done for bacteria? (Your message noted only that the physician said it didn`t look like a bacterial infection.) It also could be a dermatitis/eczema, which is more likely in someone who`s experienced dermatitis/eczema before. Psoriasis also can affect the nipples, areola and breast when a mother has that condition.
I cannot see your nipple and areola so I may be totally off base, and I`m not a physician so I do not prescribe medication; however, I am aware of physicians that recommend both a topical anti-fungal, such as nystatin for candida and/or a topical bacteriostatic ointment, such as bactroban for the bacterial infection when cultures are positive for candida and bacteria. (A physician discussing nipple wound care at the International Lactation Consultant Association [ILCA] conference this year reported having better results with bactroban than with neosporin for most such bacterial infections.) A few physicians also combine or alternate treatment using an anti-fungal and a bacteriostatic topical medication with a topical steroid medication.
If this is a fungal or bacterial infection, the baby also should treated due to exposure during breastfeeding. You and your baby may keep passing candida or bacteria back and forth if only one of you is treated. Are both breasts affected or only one? It`s even more likely that you and the baby are passing something back and forth if both breasts are affected.
Candida (yeast) definitely should be suspected if your baby has or has had thrush, which may appear as white placques in the mouth or as a bright red diaper rash. However, mothers have had candida on their nipples even when their babies were not showing any signs, so you still may want to ask your physician if it would be worthwhile to try a topical anti-fungal every 3-4 hours for a few days to see if it makes a difference. (Your physician can tell you which anti-fungal to use.) If it does help, you`d want to ask the baby`s pediatrician about medication to treat the baby too.
After using a pump and related equipment for 5 months, equipment doesn`t suddenly cause a problem such as the one you`ve experienced. Has there been a change or is something different about your pumping equipment or routine? If using the same pump and pump kit accessories (tubing, breast flange or "cups," inserts, etc.), it is unlikely that they actually caused the problem. If there has been a change in equipment, that might have contributed to the problem, especially if a change involved using any equipment pieces that were "borrowed" rather than new. (Borrowed equipment may have accidentally been contaminated by candida or bacteria. Candida can live after an hour of boiling!)
I have never had a client report the kind of reaction you had using the pump you used--with or without the inserts. The inserts are generally used only if someone`s nipples are smaller in diameter than average. When used by someone with average-size nipples, the use of the inserts may result in pinching, but I`ve never heard a mother or another lactation consultant report the dramatic reaction you had. There can always be a first time, but I`d suspect the real cause of the problem lies elsewhere. However, you could contact Medela, Inc. (800-TELL-YOU) to ask if others have reported a similar reaction and what was suggested for them.
As you probably read on the package, Lansinoh is a "purified" lanolin. Part of the purification process removes the "ingredient" that usually is involved in any allergic reaction. To see if the lanolin or any other topical medication you`ve been using on your nipples and areola is causing an allergic reaction, you could apply a very small amount to the skin on the inside of your elbow area (only one medication per elbow). If you have an allergic reaction, the skin in that area is likely to get red and may feel itchy within a few hours. (Are you using a new tube of purified lanolin or was it borrowed from someone whose fingers might have accidentally "infected" it when swiping some from the tube?)
Can you still breastfeed? Yes. Many mothers have continued to breastfeed through such infections or skin conditions. Once the actual cause is discovered and correct treatment is started, relief usually follows quickly as long as the mother does not skip times for using the recommended treatment. I do not know any mothers who`ve had permanent damage as a result of these kinds of infections or conditions. In cases I`ve familiar with, the skin healed once the correct problem was diagnosed and treatment was begun.
The best of luck as you work through this very uncomfortable problem. If you have additional questions or didn`t address something in your post, please get back in touch.
Karen Kerkhoff Gromada, MSN, RN, IBCLC
Adjunct Clinical Instructor
College of Nursing
University of Cincinnati