In this video blog, Jenny Murase, MD, summarizes her lecture, Dermatologic Care of New Mothers , given on November 10, 2024, at the 5th Annual Elevate-Derm West Conference at the Westin Kierland Resort in Scottsdale, AZ.

In this video

In conversation with PA Lisa Weiss, Dr. Murase walks through the diagnostic challenge of a nursing mother who presents with painful areola or nipple symptoms. The differential includes Candida, irritant or allergic contact dermatitis, and staph — but Candida produces lactoferrin, which makes it nearly impossible to culture outside of specialized labs, so fungal cultures often come back "artificially negative." Because diagnostic testing is so limited, she leans on therapeutic trials: roughly two weeks of an antifungal such as fluconazole, then a course of an antibacterial such as cephalexin. If pain persists — especially throbbing pain that continues after breastfeeding — she considers Raynaud's phenomenon, which responds to nifedipine.

On medication safety, Dr. Murase is emphatic that the vast majority of drugs, including biologics, do not pass into breast milk. She cites the National Psoriasis Foundation Delphi consensus she co-led with George Martin, noting that even rituximab is now considered safe. Her biggest clinical takeaway: do not take a lactating woman off her biologic, and never recommend she "pump and dump" — the health benefits of breast milk, including reduced atopic dermatitis risk in the infant, make stopping for these reasons unnecessary.

  • Candida mastitis is real but hard to confirm — Candida produces lactoferrin, so fungal cultures often read falsely negative unless run in a specialized lab.
  • Because testing is limited, use therapeutic trials: ~2 weeks of fluconazole, then an antibacterial like cephalexin 500 mg twice daily; check the infant's mouth and for diaper rash as clues.
  • Consider Raynaud's phenomenon when throbbing pain continues after breastfeeding — it responds to nifedipine (20–30 mg).
  • Nystatin ointment is a good topical antifungal choice since it isn't absorbed, and topical therapy generally works less well than oral for mastitis.
  • Do not stop a lactating patient's biologic or recommend 'pump and dump' — all biologics, even rituximab, are now considered safe in breastfeeding.