Pain beyond the first week, severe pain, cracking, fissures or localized swelling is not normal. The mother should see a doctor for further evaluation. Sore nipples, a common cause of pain, often come from the baby not latching on properly. Factors include too much pressure on the nipple when not enough of the areola is latched onto and an improper release of suction at the end of the feeding. Improper use of breast pumps or topical remedies can also contribute. Nipple pain can also be a sign of infection. Candidiasis
Symptoms of candidiasis of the breast include pain, itching, burning and redness, or a shiny or white patchy appearance. The baby could have a white tongue that does not wipe clean. Candidiasis is common and may be associated with infant thrush. Both mother and baby must be treated to get rid of this infection. First-line therapies include nystatin, ketaconazole or miconazole applied to the nipple and given by mouth to the baby. Strict cleaning of clothing and breast pumps is also required to eradicate the infection.Another non-prescription treatment of candidia is gentian violet. It usually works, and relief is rapid. It is messy, and will stain clothing. The babys lips will turn purple, but the purple will disappear after a few days. Milk stasis
Milk stasis is when the milk ducts are blocked and cannot drain properly, usually due to swelling and insufficient breast emptying during the engorgement phase. This may affect only a part of the breast and is not associated with any infection.
African histoplasmosis is a fungal infection caused by Histoplasma capsulatum var. duboisii, or Histoplama duboisii (Hcd). : 316  Disease has been most often reported in Uganda, Nigeria, Zaire (Democratic Republic of the Congo) and Senegal, as Hcd is exclusive to Africa. In human disease it manifests differently than histoplasmosis (caused by Histoplasma capsulatum, or Hcc), most often involving the skin and bones and rarely involving the lungs. Also unlike Hcc, Hcd has been reported to rarely present in those with HIV, likely due to underreporting. However, this along with the differences in Hcc and Hcd have been disputed.The favored locations of African histoplasmosis are "osteoarticular, ganglionic and pulmonary". Genitourinary skin damage is rare, occurring in only 4-11% patients and typically as a secondary skin invasion in those with disseminated infection.It presents as "localized with isolated skin, bone, or lymph node infections or disseminated with multiple cutaneous lesions present all over the body, subcutaneous abscesses, enlarged lymph nodes, liver and spleen, and visceral organ enlargement" Cutaneous manifestations can be isolated or present with nodules, papules, or ulcers. They may present with subcutaneous swelling, cold abscesses progressing to spontaneous fistulization, or ulcers that may bud. If left alone, lesions may turn into a large ulcer. See also
Histoplasmosis

References


== Further reading ==