HomeMy WebLinkAboutbreast-nipple-candidiasis-flyerBreast and Nipple Candidiasis
ICD-10 B37.89 maternal candidiasis, nipple or breast
ICD-10 Code P37.5 neonatal candidiasis
Candida of the nipple and/or breast (ductal) can
cause severe breast and nipple pain which may
result in early termination of breastfeeding. The
diagnosis of candida in the breastfeeding dyad
is based on clinical signs and symptoms and the
exclusion of other common causes of symptoms
including mastitis, eczema, bacterial infection,
and Raynaud’s Syndrome. Diagnosis of candidal
infection of the breast is challenging and research
in this area is ongoing. 21,
Signs and Symptoms of Candidiasis
Mother
•Deep stabbing or burning pain radiating throughout
the breast toward the end or after feeding (rule out
improper latching)
•Pain in both nipples or breasts is common
•Itchy, flaky or shiny nipples (rule out dermatitis)
•Nipples redder or pinker than usual or areola blanching
•Absence of pyrexia
•Signs of fungal infection in baby’s mouth or diaper region
•History of vaginal candidiasis in pregnancy or
frequent infections
•History of antibiotic use in mother or baby
Baby
•History of oral or diaper candidal infection
•Reluctant infant feeding (e.g., arching away from the breast
during feeding)
•Excessive tongue thrusting
•Short and erratic feeds
When candidiasis is identified in either infant or mother,
both always should be treated simultaneously.
2
Treatment of the Mother 3
Curtaneous Candidiasis
Treat with topical antifungals including:
•Miconazole
•Clotrimazole
•Nystatin (limited effectiveness due to
resistant strains)
•Gentian Violet diluted to 0.25–1% (Note: limit use to
once daily for 3–7 days to prevent mucosal irritation)
Note: with the exception of Gentian Violet, most
topical treatments require application to the nipple 4–8
times after breastfeeding for 14 days.
Persistent or Invasive Candidiasis
Treat with oral fluconazole:
•Fluconazole 200–400 mg followed by 100–200 mg
daily for 14–21 days (oral medication of choice since
transfer into milk and infant are low)
•Secondary option ketoconazole may be considered
•Painkillers such as ibuprofen may be indicated for
severe breast pain
Treatment of the Infant3
Agents that may be used include:
•Nystatin applied topically to the oral cavity after
every feed
3
•Gentian Violet diluted to 0.25–1% (Note: limit use
to once daily for 3–7 days to prevent mucosal
irritation)
•Encourage consistency. Mothers should wash their
hands thoroughly before and after applying the gel
Infant feeding during treatment
Women experiencing severe breast pain who are having
difficulty breastfeeding their infant are advised to express
their breast milk. Refer patients to appropriate health
professionals for breastfeeding support during treatment.
Follow-up care
If symptoms persist for 2–3 weeks following these
treatments, then bacterial infection is possible. Further
investigation is recommended which may include a
laboratory assessment of breast milk.
Associated breast care and
lifestyle measures
Women with breast and nipple candidiasis are also advised
to take the following measures:
•Ensure the infant is properly positioned and latches onto
the breast.
•Wash hands often and thoroughly especially before and
after applying any creams.
4
•Wash clothing and materials that will come into contact
with the breast in hot soapy water and air dry outside.
Cotton bras are recommended.
•Keep the nipples dry. Ideally, breast pads should not be
used. If breast pads are used, avoid cloth pads. Change
disposable pads frequently.
•Rinse nipples with warm water after each feed. Pat dry with
a clean towel and air dry with a hair dryer on a low setting.
•Pacifiers also may contribute to yeast infections and should
be avoided when possible. If used, sanitize by boiling
for five minutes. Anti-bacterial sanitizing agents may not
effectively destroy yeast organisms like C. albicans.
Risk Factors for Breast and
Nipple Candidiasis
Candida thrives in moist, warm environments. During
lactation, the breast and nipple are more vulnerable
to candida, particularly if there is:
•Nipple damage in early breastfeeding (may be due
to improper latching)
•Use of antibiotics in pregnancy or immediately
after delivery
•Previous long-term antibiotic use
•Previous vaginal candidiasis infection
5
6
•Use of breast pads, which create a moist
environment around the nipple and allow yeast
to multiply
•Chronic illness, including HIV, diabetes or anemia
References
1. Lawrence R, Lawrence R. Breastfeeding A Guide
for the Medical Profession. 8th ed. Philadelphia,
PA: Elsevier; 2016.
2. Spencer J. Common problems of breastfeeding and
weaning. Up To Date. Literature review current through
July 2015. Updated July 27, 2015.
3. Hale T, Berens P. Clinical Therapy in Breastfeeding
Patients. 3rd ed. Amarillo, TX: Hale Publishing; 2010.
The science of breastfeeding medicine is an evolving field.
Please contact us if you have any suggestions regarding the
content of these materials at CDPHWICRBL@cdph.ca.gov
or 800-852-5770. To contact your local WIC office please
see MyFamily.WIC.ca.gov.
California Department of Public Health, California WIC Program
This institution is an equal opportunity provider.
1-800-852-5770 | MyFamily.WIC.ca.gov
Rev 02/21
This document is considered a resource, but does not define
the standard of care in California. Readers are advised to
adapt the guidance based on their local facility’s level of care
and patient population served and also are advised to not
rely solely on the guidelines presented here.