StorkNet interview with
Anne Smith, IBCLC
International Board Certified Lactation Consultant

Q's and A's:

ECZEMA ON BREASTS

Allison: I have recently developed eczema on my breasts. It has been quite uncomfortable, with itching. My Dr. sent me to a dermatologist who just started me on a topical cream. I am wondering what else I can do to keep nursing. When she latches, it itches, and am worried about if the latching is irritating it worse. Is their any advice, and also is this a rare thing? Morgan is almost 5 months. And I love nursing her, do not want to ruin a good thing. Thanks, Allison

Anne: Eczema on the nipples is not uncommon. It often shows up after several weeks or months of nursing and not in the very beginning. If a yeast infection has been ruled out (the symptoms are often similar), then treatment with a steroid ointment is often effective. If your doctor has just prescribed the ointment, then I would suggest giving it time to work. If it seems to be helping, then keep using it once a day or less for a while to keep the symptoms from reoccurring.

Other methods to control eczema include not washing the nipples often, using as little soap as possible, exposing the nipples to air or sunlight, avoiding rough fabrics against the breast, and avoiding the use of perfumes or laundry detergents. The fact that your nipples stay moist and that the baby is putting stress on them every few hours doesn't help the situation. Try to wear disposable pads and change them often. These include wearing breast shells, getting the milk to let down before you start nursing, and nursing on the least sore side first.

Sometimes nursing mothers have a combination of eczema and yeast at the same time. If the rash and itching don't respond to the medication your dermatologist prescribed (I'm assuming it was some kind of steroid) then that option needs to be explored. The most effective treatment I've found is Dr. Jack Newman's nipple ointment. Jack Newman's nipple ointment is excellent. Mix an anti-fungal cream (I recommend Nizoral, but you can also use a combination of Nystatin (100,000 units/ml, 15 gms) and Clotrimazole (10% cream, 15 gms). These are anti-fungals to treat the candida. In addition, the cream contains Mupricon (antibiotic - 2% ointment, 15 gms) and Betamethasone (cortocosteroid to decrease inflammation -0.1% ointment. 15 gms). In his new book, Dr. Jack Newman's Guide to Breastfeeding, pp.108-109, he recommends applying the ointment after each feeding and not washing it off. You gradually cut back on the applications as the pain disappears.

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