Signs of nipple yeast infection

What does a nipple yeast infection look like?

A nipple yeast infection usually appears as a rash on the part of the areola that is covered by the baby’s mouth during breastfeeding. This area may be red, shiny, flaky, swollen, or wrinkled. A sharp boundary usually appears at the edge of the rash and the normal skin of the areola. In mothers of older babies or children, infection can be limited to a small part of the areola around the nipple. If not quickly treated, fine cracks may appear where the nipple meets the areola. These can become infected with bacteria, increasing the pain and damage, and this infection may even move into the breast causing mastitis or a breast abscess.

A) Skin changes with nipple yeast infection

Yeast infection causing redness of the central areola and flaking at the edge of the rash.

If a nipple yeast infection is not treated as soon as the pain starts, the skin begins to change, generally after a week. This can be the start of a cascade of increasingly painful problems.

Candida, the yeast that causes nipple yeast infection, needs moisture. During breastfeeding, only the nipple and central areola are wet from the baby’s mouth and milk, so the rash caused by nipple yeast infection generally affects only this area. The outer areola is unaffected. 

The following changes may occur on the breast (Francis-Morrill 2004):

  • The central areola may be:
    • Red from where the nipple meets the areola (nipple bottom) to the edge of the rash.
    • Shiny, flaky, swollen, or wrinkled.
  • A sharp boundary usually appears between the rash and the normal skin of the areola.
  • The boundary may be flaky.

Untreated, a nipple yeast infection may spread to the outer areola and other parts of the breast. When a rash appears as spots away from the main rash, they are called satellites. However, this is not common and we have only seen it once. If you have a rash farther onto the breast, it is much more likely to be areolar eczema rather than a nipple yeast infection. Breast cancer can also spread onto the breast.

B) Cracks cause by nipple yeast infections

Cracks at the bottom of the nipple caused by a yeast infection.

1) Nature of the cracks

If not treated early, nipple yeast infection can cause thin lines of skin damage (cracks) at the nipple bottom. These are very narrow or fine. The cracks may come and go over a week as old cracks heal and new ones form.

They can affect a small part of the nipple bottom or completely ring it.

2) Bacterial infection of nipple yeast infection cracks

Nipple cracks caused by yeast infection occasionally become infected by bacteria. This happens because the crack allows bacteria on the nipple to enter the body.

Cracks may be infected with bacteria when they:

  • Produce a creamy liquid (pus).
  • Stick to your breast pad.
  • Swell along the edges.
  • Get redder along the edges than they were before.
  • Get wider or more painful.
  • Don't heal. 

See your health-care providers as soon as possible if your notice these signs and consider antibiotic ointments or pills. Left untreated, bacteria can move into the breast and cause mastitis and even in a breast abscess. Fortunately, this is rare. Our clinic has only seen this a few times.

C) Skin changes when breastfeeding older babies or children

Asymmetrical rash caused by a yeast infection while breastfeeding a toddler.

Older babies normally do not cover as much of the areola with their mouths when latched as newborn babies, so the rash of Candida may be limited to a small part of the areola around the nipple.

Older babies or children sometimes breastfeed with the mouth covering one side of the areola more than the other, so the rash around the areola is not symmetrical.

D) Skin changes after treatment

On rare occasions, the inflammation from nipple yeast infections cause the cells that give the areola its brown colour, to die. The central areola then becomes pale. This will be noticeable after the redness has cleared.

E) Thrush

Thrush may be seen in the baby's mouth and should be treated.

References

Francis-Morrill J, Heinig MJ, Pappagianis D, et al. Diagnostic value of signs and symptoms of mammary candidosis among lactating women. J Hum Lact. 2004 Aug;20(3):288-95