by Jack Newman, MD, FRCPC
Gentian violet (1% solution in water) is still an excellent treatment for Candida Albicans, though we don't suggest mothers use it alone for Candida Albicans (thrush, yeast) because it tends to dry out the nipple and areola. Furthermore, it does not seem to work as well as it used to.
Candida albicans is a fungus that may cause an infection of skin and/or mucous membranes (inside of mouth, for example) in both children and adults. In small children, this yeast is a frequent cause of white patches in the mouth (thrush), or diaper rash.
When the nursing mother has a Candidal infection of the nipple, she may experience severe nipple pain, as well as deep breast pain. Please note: Gentian violet 1% in water also contains alcohol (10% by volume), but the amount of alcohol in the tiny amount of gentian violet you use is of no concern. Apparently some pharmacists are now dissolving it in glycerin, thus avoiding the use of alcohol, but if gentian violet is used as directed baby will get vanishingly small amounts.
The pain caused by a Candida infection is generally different from the pain caused by poor positioning and/or ineffective suckling. The pain caused by a Candida infection:
• Is often burning in nature, rather than the sharp, stabbing or pinching pain associated with other causes (such as a poor latch). Burning pain may be due to other causes, however, and pain due to a Candida infection does not necessarily burn.
• Frequently lasts throughout the feeding, and occasionally continues after the feeding has ended. This is in contrast to the pain due to other causes that usually hurts most when the baby latches on, and gradually improves as the baby sucks (unless nipple damage is very severe, in which case the pain may continue throughout the feeding).
• May radiate into the mother's armpit or into her back. This does not mean that the Candida actually is inside the breast or in the ducts. Pain that is felt in a place where there is no cause of the pain, but due to pain elsewhere in the body is called "referred pain." An example is pain in the neck which is actually due to heartburn which may also be felt at the lower end of the breast bone.
• 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 and the nipple may crack.
• Not uncommonly will begin after a period of pain free nursing. This characteristic alone is reason enough to try treatment for Candida. However, milk blisters on the nipple also may cause nipple pain after a period of pain free nursing as may eczema or other skin condition. Also, if the mother's milk supply diminishes, the mother may start having pain later on since babies tend to slip down on the breast when the flow is slow. Another possibility is a new pregnancy, which in itself can cause sore nipples and since the milk production decreases during pregnancy may cause soreness also for that reason.
• May be associated with recent use of antibiotics by the baby or mother, but not necessarily.
• May be quite severe, may or may not be itchy.
• May occur in one breast or nipple only.
• 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 since mastitis is associated with a large painful lump in the breast; therefore, there is no reason to treat with antibiotics. On the contrary, antibiotics may make the problem worse.
a) The baby does not have to have thrush in his mouth.
b) A Candida infection of the nipple may be combined with other causes of soreness.