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Candida or thrush is a common infection of the skin caused by yeast (Candida albicans). However, it rarely, if ever affects normal skin. It is generally an infection which occurs in the presence of skin which is already abnormal in some way. It often occurs where the skin is kept moist or warm, such as in folds of skin. It may occur in an underlying dermatitis or eczema of the skin.

The major problem in breastfeeding women is that with wetting and drying and the constant moisture and warmth from a suckling baby, the skin of the nipple tends to dry out. This leads to a mild eczema with splitting and painful cracking of the nipples. In these circumstances the candida then can infect the eczema and looks like small white spots. There also may be some breast pain.

Candida infection may be more likely to occur when antibiotics have been taken for some other infection. It may also occur as a result of candida (thrush) infection in the mouth of the baby.

The most important measure in preventing candida of the nipple is to avoid eczema associated with drying, splitting and cracking of the nipple. Soap should be avoided when washing the skin. Regular application of moisturisers such as emulsifying ointment, other paraffin based ointments or creams, or one of the newer lanolin-containing products should be used if the nipple is becoming dry.

Try to change breast pads frequently and avoid breast pads that have plastic backing. Airing the nipples may help to avoid cracking.

Eczema with inflamed, cracked or irritated nipples may be treated with a cortisone cream prescribed by a doctor. It would be used in association with specific anti-candida creams to treat the thrush. The nipple can be washed with a small amount of aqueous or sorbolene cream before breastfeeding. If the condition has become severe, it may be necessary to take the baby off the affected breast for several days. During this time the milk should be expressed by hand or pump and may be fed to the baby by bottle or other suitable means.

If the candida has occurred following the use of oral antibiotics, there may be a need for an oral anti-candida treatment as well. Any candida (thrush) in the baby’s mouth should also be treated.

Once the candida and eczema have settled, regular use of moisturisers to the nipple is necessary to prevent return. The use of soap should also be avoided.

Your Maternal and Child Health nurse.
Your pharmacist.
A lactation consultant.
Your family doctor.
A dermatologist.

Related Information Sheet: Candida (Thrush) in Babies

© 2002, Department of Dermatology, St. Vincent’s Hospital Melbourne, Victoria Parade, Fitzroy, Victoria 3065 Australia.