Lactating Women with Persistent Nipple and Breast Pain may not always have a yeast infection

Healthcare providers treating lactating women for nipple and breast pain often regard these symptoms as Candida albicans infections. However, multiple other conditions may also show pain, erythema, and pruritis. The present study explored the experience of a breastfeeding medicine practice that received referrals for patients failing antifungal therapy and who desired further evaluation for alternative diagnoses.

It enrolled breastfeeding women who were referred for evaluation of "yeast" to a breast surgery/breastfeeding medicine practice.

The study observed-

• Inclusion of Twenty-five women. 
• Median age as 33 (range 24–43), and the median months postpartum as 4 (range 0.5–18). 
• Minimal to no improvement in oral and/or topical antifungal therapy in all 25 women. 
• Along with history and examination, milk culture was requested in four women, punch biopsy in one, and core needle biopsy in one. 
• No woman received a confirmed diagnosis of Candida. 
• The changed diagnoses included: subacute mastitis/mammary dysbiosis (n = 8), nipple bleb (n = 6), dermatitis (n = 6), vasospasm (n = 2), milk crust (n = 1), hyperlactation (n = 1), and postpartum depression (n = 1).
• Discontinuation of antifungal medication and treatment as per individual diagnoses: antibiotics and probiotics; 0.1% triamcinolone cream; heat therapy; discontinuation of exclusive pumping; and antidepressant medication and counseling referral. 
• Resolution of symptoms following revision of diagnosis and change in management (range 2–42 days) in all women.

This study shows that although persistent nipple and breast pain in breastfeeding is often due to Candida, the providers should consider multiple other conditions in their differential diagnosis. Accurate and timely diagnosis is crucial, as pain is a risk factor for premature cessation of breastfeeding. Symptomatic resolution occurs with appropriate therapy.

Betts RC, Johnson HM, Eglash A, Mitchell KB. It's Not Yeast: Retrospective Cohort Study of Lactating Women with Persistent Nipple and Breast Pain. Breastfeeding Medicine.Apr 2021.318-324.http://doi.org/10.1089/bfm.2020.0160