Yeast Infections of the Nipples and Breasts

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Yeast Infections of the Nipples and Breasts
By Kathleen L. Hoover, M Ed, IBCLC
A breastfeeding mother has many concerns while providing the
optimum nutrition for her baby. A yeast infection, such as thrush, is
an annoying and unwelcome problem but one that is quite com-
mon in newborns and their mothers. There are a wide variety of
medications available to deal with yeast infections. Also, there are
many steps you can take around your home, in your diet and with
your personal care that will help stop the spread of infection and
bring recovery more quickly. The first step, however, once you sus-
pect there is a problem, is to have your baby’s primary care practi-
tioner confirm the diagnosis, so you can begin a treatment pro-
gram for both you and your baby.
The What, Where and How of Yeast Infections
Yeasts are one-celled organisms that live in and on our bodies.
Bacteria are also a normal part of our bodies. It is only when the
yeast overgrows that it becomes a problem. As pregnancy progresses, a woman is more likely to have an overgrowth of
yeast.12 At birth a vaginal overgrowth of yeast can be transferred to the baby, and the baby can end up with thrush (an oral
yeast infection).
A yeast infection can show up in many places. Infants typically develop yeast infections in the diaper area and in their mouths.
Babies get yeast infections easily since their immune systems are not fully developed. The most common place for women to
have a yeast infection is in the vagina, and sometimes women with large breasts will have a yeast infection under their breasts.
When a woman is breastfeeding, she can get a yeast infection on her nipples and sometimes even inside her breasts. Men
may have “jock itch” and any family member can have a yeast infection anywhere on the body. Between toes (“athlete’s foot”)
or under fingernails and toenails are common places. There is even a form of dandruff that is caused by yeast. Because family
members are in close contact, it is easy to spread a yeast infection from one family member to another.
Predisposing factors include:
G Pregnancy
G Infancy
G A history of vaginal yeast infections
G Recent antibiotic use
G Living in a warm, moist climate
G A yeast infection of another family member, pet or farm animal
G Wearing artificial fingernails or dentures
G Use of steroids
G Anyone with a compromised immune system
Women who have recently given birth may have been treated with antibiotics for a Cesarean birth or for GBS (Group B b-
hemolytic Streptococcal infection). Treatment with antibiotics destroys some of the body’s helpful bacteria (as well as harmful
bacteria). One function of the good bacteria is to keep the yeast from overgrowing. If you have been on antibiotics recently, you
can take acidophilus to help reestablish the good bacteria in your body. Acidophilus can be found in the refrigerated case of
your local health food store, and some supermarkets also carry it in their dairy sections. The container label will state how
much and how often to take the acidophilus. Remember to keep the acidophilus refrigerated.
When a baby develops thrush, there are visible white patches in the baby’s mouth,14 especially on the tongue. Of course the
baby’s tongue can look white from milk. Try to wipe off the white substance with a wet washcloth. If it is yeast, it will not wipe
off. Sometimes a baby can have a yeast overgrowth but not yet have visible white growth in the mouth. If a baby has a yeast
infection in the diaper area, the baby’s bottom is red and irritated. Sometimes for people with dark skin, the infected area may
appear darker than their normal skin color.

Seek Professional Treatment
If you suspect that your baby has a yeast infection, call for an appointment with your baby’s primary care practitioner (pediatri-
cian, family practice doctor, nurse practitioner, or clinic). You and your baby will need medicine to treat the infection. Ask your
baby’s practitioner to write a prescription for your nipples, or call your primary care practitioner (family doctor, obstetrician, mid-
wife, nurse practitioner, or clinic). You need to be treated at the same time as your baby.8 Sometimes your practitioner may
prescribe an over-the-counter medicine.
There are several different antifungal medicines. Most pediatricians start with a prescription for oral nys-
tatin solution (Mycostatin“, Nilstat“). To apply the solution, place the dose in a small paper cup. Use a cot-
ton swab to apply the nystatin to all the surfaces of the baby’s mouth. Nystatin works by coming into con-
tact with the yeast. Be sure to get between the gums and cheeks and under the tongue as well as the
roof of the mouth. The baby can drink any medicine left in the cup. The manufacturer recommends treat-
ment four times a day. Since yeast grows quickly, some doctors suggest treating more often.7 For
instance, use half the dose eight times a day. Other medicines that can be used to treat the baby include
fluconazole (Diflucan“), amphotericin B (Fungizone“), and gentian violet.11 Your caregiver will tell you how
to use the medicine since each medicine is used differently.4 If you use gentian violet, PureLan™ can be
put on the baby’s lips to keep the baby’s face from getting purple.
For your nipples, you will be prescribed an antifungal ointment or cream. Apply the ointment sparingly
after each breastfeeding. Rub it onto your nipples and the area of the breasts that the baby’s mouth cov-
ers. By the next feeding most of the medicine will have rubbed off on your clothing or breast pads, so
there is no need to wash the nipples before breastfeeding.10 If there is a large amount of medicine left,
then you may wish to wipe it off gently before feeding your baby. Perhaps olive oil on a cotton ball would
be a good method to remove the ointment. If you are using breast pads, a fresh set should be used fol-
lowing each feeding. It is important to put on a clean bra every day.
The names of the most common antifungal ointments and creams are miconazole (Mycatin“, Monistat“,
Desenex“), clotrimazole (Lotrimin“, Mycelex“, Desenex“), ketoconazole (Nizoral“), and nystatin
(Mycostatin“, Nilstat“, Nystex“). There are several other antifungals.4
What You Can Do to Speed Recovery
What can a family do to reduce the spread of infection? Hand washing is very important when someone
in a family has a yeast infection. Regular soaps would probably be best to use instead of antibacterial
soaps, because helpful bacteria are important to keep the yeast from overgrowing. Since yeast can live
on a moist towel,2 using paper towels for hand drying during a yeast infection may help reduce the
spread of yeast. After the daily bath or shower, the towel should be washed and completely dried before
using it again. Also clothing should be washed in the hottest water possible for the fabric.
It usually takes a good two weeks of treatment for thrush to clear completely. If the thrush returns, it is
suggested that you return to applying the baby's oral nystatin solution while you use the topical ointment
on your nipples. Continue this treatment for two weeks beyond the time when your nipples are feeling
comfortable and the white patches in your baby's mouth are gone.
Sometimes the baby’s thrush can spread to your nipples. Some women describe burning nipple pain
when they have a yeast infection.1 In addition to applying the medicine, women have taken pain medicine
and worn breast shells to relieve some of the nipple discomfort. If the nipples are not treated, some
women may experience shooting, burning pain all through their breasts.13 If your breasts hurt you may
be treated with oral fluconazole (Diflucan“) for two weeks or more.5 This medicine can be used safely for
most breastfeeding mothers and babies.

If your nipples are so painful that you do not want to breastfeed your baby, you can rent a hospital-grade,
electric breast pump to express milk frequently until your nipples feel better. The milk you express should
be fed to your baby. Bottles, nipples, pacifiers, breast shells, and pump kit parts need to be washed in
hot, soapy water after each use, dry with paper towels, and boiled for 20 minutes once a day.
If your nipple pain does not improve after five days of treatment, contact your healthcare provider. You
may need a different antifungal ointment. If you have a cracked nipple there could be a bacterial infec-
tion9 along with the fungal infection. Your doctor can prescribe an antibiotic ointment such as mupirocin3
(Bactroban“) or polymyxin B sulfate plus bacitracin zinc (Polysporin“) that you can use along with the
antifungal medicine. Any time there is a crack in the skin, it should be washed once or twice a day with
warm soapy water. Other dermatological problems can occur at the same time as a yeast infection.
Sometimes, doctors will prescribe a steroid ointment such as 0.05 percent betamethasone along with the
antifungal and antibiotic ointments.10
The nature of yeast is that it grows in warm, moist places with access to sweet food (much like when
yeast is added to warm water and sugar for bread baking). Women have reported that decreasing sugar
in their diets was helpful to reduce yeast infections.6
If Follow-up is Needed
A person who has problems with repeated infections should have a thorough check-up and boost their own immune system
with vitamins, minerals, and plenty of water. The best way to keep yeasts from overgrowing is to have a healthy body with
intact skin.
If you are having problems curing a yeast infection or with repeated yeast infections, talk to your primary health care practition-
er, your breastfeeding support group, and a lactation consultant. They may be able to give you additional information and emo-
tional support at this difficult time.
Kay Hoover is an International Board Certified Lactation Consultant who has been in private practice in the Philadelphia area
since 1986.
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Investigation 41:30-34, 1996
2 Amir L, Hoover K, Mulford C: Candidiasis & Breastfeeding (Unit 18). Lactation Consultant Series. New York: Avery Publishing
Group, 1995
3 De Wet PM, Rode H, van Dyk A et al. Perianal candidosis – a comparative study with mupirocin and nystatin. Int J Dermatol
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7 Hughes WT: Persistent thrush in young infants. The Pediatric Infectious Disease Journal 6(11):1074-1075, 1987
8 Lawrence RA, Lawrence RM: Breastfeeding: A Guide for the Medical Profession, 5th edition. Philadelphia: C.V. Mosby
Company, 610, 1999
9 Livingstone V, Willis C, Berkowitz J: Staphylococcus aureus and sore nipples. Canadian Family Physician 42:654-659, 1996
10 Newman J, Pitman T: Dr. Jack Newman’s Guide to Breastfeeding. Toronto, Ontario: HarperCollins Publishers Ltd, 2000
11 Piatt JP, Bergeson PS: Gentian violet toxicity. Clinical Pediatrics 31(12):756-757, 1992
12 Sobel JD. Epidemiology and pathogenesis of recurrent vulvovaginal candidiasis. Am J Obstet Gynecol 1985; 152(7 Pt
13 Tanguay KE, McBean MR, Jain E: Nipple candidiasis among breastfeeding mothers. Canadian Family Physician 40:1407-
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14 Wilson-Clay B, Hoover K: The Breastfeeding Atlas. Austin, TX: LactNews Press, 1999