Caring for new mothers: diagnosis, management and treatment of nipple dermatitis in breastfeeding mothers

Heller, Misha M.; Fullerton-Stone, Honor; Murase, Jenny E.

doi:10.1111/j.1365-4632.2011.05445.x

Cited by 38 publications

(66 citation statements)

References 45 publications

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“…However, nursing mothers are prone to nipple pain due to dermatitis and the development of new psoriasis plaques (koebnerization; Fig. 1; Heller et al, 2012). PSO and PsA management before, during, and after pregnancy is highly important to achieve optimal outcomes for both mothers and infants (Porter et al, 2017).…”

Section: Psoriasis and Pregnancymentioning

confidence: 99%

Clinical considerations for the management of psoriasis in women

Gottlieb

Ryan

Murase

2019

International Journal of Women's Dermatology

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The burden of psoriasis is particularly high for women, who report lower levels of happiness (women: 18.5%; men: 11.3% lower vs. general population) and are more likely to experience stress (women: > 60%; men: 42%), loneliness (women: 25-28%; men: 19-24%), stigmatization (Feelings of Stigmatization Questionnaire score; women: 93.2; men: 78.0), and reduced sexual activity (women: 33%; men: 19%) compared with men. The onset of psoriasis is bimodal, with one incidence peak (15-30 years) that coincides with the prime reproductive age for women, which poses specific challenges for their treatment. However, well-established guidelines for the treatment of women of childbearing age are lacking. Many women experience stabilization (21%) or improvement (55%) of their skin during pregnancy, but up to a quarter can experience disease worsening, and postpartum flares are common (> 50%). Therefore, balancing the risk of treatment with the risk of uncontrolled disease is important. Because half of pregnancies are unplanned, the implications of therapeutic options must be considered for all women with psoriasis who are sexually active, irrespective of intentions to start a family. Timely initiation of these discussions by health care professionals is paramount to prevent unintentional toxicity to the developing fetus. For example, acitretin, methotrexate, and oral psoralen/ultraviolet A are all contraindicated in pregnancy. Reassuringly, safety data for other psoriasis treatments during pregnancy are increasingly available, particularly for anti-tumor necrosis factor therapies. Despite encouraging data from pregnancy exposure registries and clinical studies now being included in anti-tumor necrosis factor drug labels, comfort with prescribing these therapies to pregnant women remains low (U.S. dermatologists: 21%; EU-5 dermatologists: 10%). In this article, we review issues specific to treating women of childbearing age with psoriasis and highlight the need for treatment guidelines to ensure consistent care and optimal outcomes for these patients.

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Section: Psoriasis and Pregnancymentioning

confidence: 99%

Clinical considerations for the management of psoriasis in women

Gottlieb

Ryan

Murase

2019

International Journal of Women's Dermatology

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“…Gentian violet has also been used extensively for oral candidasis (thrush). Painting the mouth of an infant with oral thrush with GV has for more than 90 years been a safe and effective treatment . More recently, GV has been used to treat oral candidasis in human immunodeficiency virus (HIV)‐infected individuals, especially in developing countries where treatment with fluconazole is impractical due to availability, cost of treatment and the development of resistance .…”

Section: Antimycotic Activitymentioning

confidence: 99%

Gentian Violet: a 19th century drug re‐emerges in the 21st century

Maley

Arbiser

2013

Experimental Dermatology

129

108

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Gentian violet (GV) has a long and varied history as a medicinal agent. Historically used as an anti-bacterial and anti-fungal, recent reports have shown its utility as an anti-typranosomal, anti-viral and anti-angiogenic agent. The objective of this paper is to summarize evidence regarding the efficacy, and safety of GV use in dermatology. Recent discoveries have found novel targets of GV, namely NADPH oxidase in mammalian cells and thioredoxin reductase 2 in bacterial, fungal, and parasitic cells. These discoveries have expanded the use of GV in the 21st century. Given that GV is well tolerated, effective and inexpensive, its use in dermatology is predicted to increase.

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“…While some authors use the term ‘candida mastitis’,6 11 13 we feel this is misleading, as inflammation of the breast is not evident. Although some clinicians attribute the pain to infection with S aureus and treat women with long-term antibiotics,14 this has not been tested in trials.…”

Section: Introductionmentioning

confidence: 96%

“…19 The pain due to vasospasm is often secondary to nipple damage or infection, exacerbated by cold and relieved by heat or nifedipine 20. In practice, more than one cause of nipple or breast pain is commonly present,6 which makes it difficult to construct a case definition for ‘breast thrush’ for research purposes.…”

Section: Introductionmentioning

confidence: 99%

DoesCandidaand/orStaphylococcusplay a role in nipple and breast pain in lactation? A cohort study in Melbourne, Australia

et al. 2013

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ObjectiveTo investigate Candida species and Staphylococcus aureus and the development of ‘nipple and breast thrush’ among breastfeeding women.DesignProspective longitudinal cohort study.SettingTwo hospitals in Melbourne, Australia (one public, one private) with follow-up in the community.Participants360 nulliparous women recruited at ≥36 weeks’ gestation from November 2009 to June 2011. Participants were followed up six times: in hospital, at home weekly until 4 weeks postpartum and by telephone at 8 weeks.Main outcome measuresCase definition ‘nipple and breast thrush’: burning nipple pain and breast pain (not related to mastitis); detection of Candida spp (using culture and PCR) in the mother's vagina, nipple or breast milk or in the baby's mouth; detection of S aureus in the mother's nipple or breast milk.ResultsWomen with the case definition of nipple/breast thrush were more likely to have Candida spp in nipple/breast milk/baby oral samples (54%) compared to other women (36%, p=0.014). S aureus was common in nipple/breast milk/baby samples of women with these symptoms as well as women without these symptoms (82% vs 79%) (p=0.597). Time-to-event analysis examined predictors of nipple/breast thrush up to and including the time of data collection. Candida in nipple/breast milk/baby predicted incidence of the case definition (rate ratio (RR) 1.87 (95% CI 1.10 to 3.16, p=0.018). We do not have evidence that S aureus colonisation was a predictor of these symptoms (RR 1.53, 95% CI 0.88 to 2.64, p=0.13). Nipple damage was also a predictor of these symptoms, RR 2.30 (95% CI 1.19 to 4.43, p=0.012). In the multivariate model, with all three predictors, the RRs were very similar to the univariate RRs. This indicates that Candida and nipple damage are independent predictors of our case definition.

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Caring for new mothers: diagnosis, management and treatment of nipple dermatitis in breastfeeding mothers

Cited by 38 publications

References 45 publications

Clinical considerations for the management of psoriasis in women

Clinical considerations for the management of psoriasis in women

Gentian Violet: a 19th century drug re‐emerges in the 21st century

DoesCandidaand/orStaphylococcusplay a role in nipple and breast pain in lactation? A cohort study in Melbourne, Australia

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