Mastitis and Yeast Infection

QUESTION: My wife was diagnosed with mastitis and in treating it, was also infected with thrush. Baby has yeast infection on bottom and we are treating that with a prescription. My wife is having great trouble with her right breast. We think it is a plugged milk or nipple duct. We have treated it with heat and all other suggestions. We have also noticed that she has a white film over part of her nipple. Could this be dried milk that is contributing to the plugged duct? If so, how do we remove it without damaging her nipple?

Dan,

It is so wonderful of you to be asking for your wife, this shows a wonderful commitment and support from you! In order for me to be able to really help your wife I am going to need more information. For example, you say she was treated for mastitis - what were her symptoms, what was her treatment, and what was the name of the antibiotic that was prescribed? This information is critical in order to really find out if your wife received the proper treatment for a complete recovery or if she might be dealing with the same situation. Antibiotic treatment for either the mother or the baby can, and in many cases, leads to thrush. In order to get rid of the thrush it is necessary for both mother and baby to be treated simultaneously. The treatment should also continue for at least 2 weeks when symptoms have ended.

If baby Dan is been treated for thrush at this time, your wife should also be in treatment. Below I will enclose treatment with an over the counter product called Gentian Violet. I strongly recommend this type of treatment to properly treat the thrush and thus be able to deal with any other problems. The white film on the nipple may, may, also be thrush on the nipple. Is this film present all of the time or just after nursing. Please ask your wife to describe her pain/discomfort which may give me a better indication of what she may be dealing with. At this time, don't attempt to remove the white film since they may lead to more nipple trauma. Hope this helps.

Yvonne C. Bannister, B Sc, CBC, LLLL, IBCLC

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Using Gentian Violet

Gentian violet (1% solution in water) is an excellent treatment for Candida albicans. Candida albicans is a yeast which may cause an infection of skin and/or mucous membranes in both children and adults. In small children, this yeast may cause white patches in the mouth (thrush), or diaper rash. When the nursing mother has a yeast infection of the nipple, she may experience severe nipple pain, as well as deep breast pain.

Nipple pain caused by Candida albicans

The pain caused by a yeast infection is generally different from the pain caused by poor positioning and/or ineffective suckling. The pain caused by a yeast infection:

1. is often burning in nature, rather than the sharp, stabbing or pinching pain associated with other causes. Burning pain may be due to other causes, however, and pain due to a yeast infection does not necessarily burn.

2. frequently lasts throughout the feeding, and occasionally continues after the feeding has ended. This is in contrast to the pain due to other causes which usually hurts most as feeding begins, and gradually improves as the baby nurses.

3. may radiate into the mother's armpit or into her back.

4. may cause no change in appearance of the mother's nipples or areolas, though there may be redness, or some scaling, or the skin of the areola may be smooth and shiny.

5. not uncommonly will begin after a period of pain free nursing. This characteristic alone is reason enough to try treatment for yeast. However, milk blisters on the nipple also may cause nipple pain after a period of pain free nursing.

6. may be associated with recent use of antibiotics by the baby or mother, but not necessarily.

7. may be quite severe, may or may not be itchy.

8. may occur only in the breast. This pain is often described as "shooting", or "burning" in nature, and is often worse after the feeding is over. It is often said to be worse at night. At the same time, the breast appears or feels normal. This is not mastitis and there is no reason to treat with antibiotics. On the contrary, antibiotics may make the problem worse.

Please Note:

a) The baby does not have to have thrush in his mouth.

b) A yeast infection of the nipple may be combined with other causes of soreness.

Using Gentian Violet

We believe that gentian violet is the best treatment of nipple soreness due to Candida albicans for the breastfeeding mother. This is because it works almost always, and relief is rapid. It is messy, and will stain clothing, but not skin. The baby's lips will turn purple, but the purple will disappear after a few days. Gentian violet is available without prescription but is not available at all pharmacies. Call around before going out to get it.

1) About 10 ml (two teaspoons) of gentian violet is more than enough for an entire treatment.

2) Many mothers prefer doing the treatment just before bed so that they can keep their nipples exposed and not worry about staining their clothing. The baby should be undressed to his diaper, and the mother should be uncovered from the waist up. Gentian violet is messy.

3) Dip an ear swab (Q-tip) into the gentian violet.

4) Put the purple end of the ear swab into the baby's mouth and let him suck on the swab for a few seconds. The gentian violet usually spreads around the mouth quickly. If it does not, paint the inside of the mouth to cover as much of the inside of the cheeks and tongue as possible.

5) Put the baby to the breast. In this way, both the baby's mouth and your nipple are treated.

6) If, at the end of the feeding, you have a baby with a purple mouth, and two purple nipples, there is nothing more to do. If only one nipple is purple, paint the other one with the ear swab and the gentian violet. In this way, the treatment is finished in one go.

7) Repeat the treatment each day for three or four days.

8) There is often some relief within hours of the first treatment, and the pain is usually gone or virtually gone by the third day. If it is not, it is unlikely that Candida was the problem, though it seems Candida albicans is starting to show some resistance to gentian violet, as it is to other antifungal agents. Of course there may be more than one cause of nipple pain, but after three days the contribution to your pain caused by Candida albicans should be gone. Do not continue the gentian violet if no relief occurs after 3-4 days of treatment. Instead, get more information.

9) All artificial nipples that the baby uses should be boiled daily during the treatment, or well covered with gentian violet. Consider stopping artificial nipples.

10) There is no need to treat just because the baby has thrush in his mouth. The reason to treat is the mother's and/or the baby's discomfort. Babies, however, do not commonly seem to be bothered by thrush.

11) Uncommonly, babies who are treated with gentian violet develop sores in the mouth which may cause them to reject the breast. If this occurs, or if the baby is irritable while nursing, stop the gentian violet immediately, and contact the clinic. The sores clear up within 24 hours and the baby returns to feeding.

If the infection recurs, treatment can be repeated as above. But if the infection recurs a third time, a source of reinfection should be sought out. The source may be the mother who may be a carrier for the yeast (but may have no sign of infection elsewhere), or from artificial nipples the baby puts in his mouth. Treatment of the mother (usually with a medication other than gentian violet) at the same time as treatment is repeated for the nipples will usually eliminate reinfection. Contact the clinic.

Handout #6. Using Gentian Violet Revised January 1998

Written by Jack Newman MD, FRCPC

May be copied and distributed without further permission

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