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-มารดาที่มีผื่นแดงหรือลมพิษร่วมกับอาการคัน ควรตรวจสอบการแพ้สบู่ ผงซักฟอก น้ำยาซักผ้าหรือปรับผ้านุ่ม น้ำหอม หรือครีมที่ใช้สัมผัสกับหัวนมหรือเต้านม การดูแลรักษา ควรหลีกเลี่ยงสารที่ทำให้เกิดอาการแพ้ และอาจใช้ยาแก้แพ้ช่วยบรรเทาอาการ

? ? ? ? ? -มารดาที่มีผื่นแดง อักเสบ เป็นสะเก็ด และแห้ง ร่วมกับมีประวัติการเป็นผื่นแดง อักเสบในบริเวณอื่นๆ ควรตรวจสอบอาการผื่นแดงอักเสบ (eczema) และให้การดูแลรักษาโดยให้ยาแก้แพ้ และยาทาสเตียรอยด์เฉพาะที่ แต่ยาทานี้ต้องล้างออกก่อนการให้นมบุตร

? ? ? ? ? -มารดามีตุ่มหรือผื่นแดง ลักษณะแยกจากกัน และมีน้ำเหลืองไหลออกมา ควรตรวจสอบการอักเสบติดเชื้อที่ผิวหนัง ที่เรียกว่า Impetigo ซึ่งจะเป็นการติดเชื้อจากเชื้อ streptococcus หรือ staphylococcus การดูแลรักษาจำเป็นต้องได้รับยาปฏิชีวนะเพื่อฆ่าเชื้อ

? ? ? ? ? -มารดาที่มีการอักเสบแดง และกดเจ็บของเต้านมร่วมด้วย ควรตรวจสอบการอักเสบหรือการติดเชื้อของเต้านม (mastitis) การดูแลรักษาอาจจำเป็นต้องใช้ยาปฏิชีวนะเพื่อฆ่าเชื้อ

-มารดามีหัวนมเป็นสีชมพู ใสเป็นมัน และเป็นสะเก็ด ควรตรวจสอบการติดเชื้อรา การดูแลรักษาจำเป็นต้องใช้ยาฆ่าเชื้อราได้แก่ Gentian violet ทาบริเวณหัวนม และอาจต้องใช้ทาในปากทารกด้วย

? ? ? ? ? -มารดามีตุ่มใส และบริเวณฐานของตุ่มเป็นสีแดง ต้องตรวจสอบการอักเสบจากการติดเชื้ออีสุกอีใส (varicella) หรือการกลับเป็นซ้ำของงูสวัด

? ? ? ? ? -มารดาที่มีตุ่มอักเสบ เป็นหลุม ร่องหรือเป็นรู ร่วมกับทารกมีอาการลักษณะเดียวกัน ควรตรวจสอบการอักเสบจากหิด ซึ่งจำเป็นต้องรักษาหิด

? ? ? ? ? ?-มารดามีตุ่มอักเสบและมีร่องรอยของแมลงกัด หรือต่อย การดูแลรักษาต้องรักษาการปวดหรือคันตามอาการ แต่ควรหลีกเลี่ยงหรือป้องกันการกัด หรือต่อยของแมลงที่จะเกิดต่อไปด้วย

? ? ? ? ? ? สำหรับอาการคันของมารดาที่มีผื่นแดง อักเสบ ร่วมกับการคลำได้ก้อน อาจสงสัย Paget disease ซึ่งเป็นอาการทางผิวหนังของผู้ป่วยที่เป็นมะเร็งเต้านม สิ่งนี้มีอันตรายและมีความจำเป็นเร่งด่วนในการรักษา อย่างไรก็ตาม อาการคันหัวนมของมารดา สาเหตุส่วนใหญ่มักเป็นภาวะที่ไม่มีอันตรายรุนแรง ความผิดปกติหรือสาเหตุจากมะเร็งพบน้อย แต่หากดูแลรักษาเบื้องต้นแล้วอาการไม่ดีขึ้น ควรปรึกษาแพทย์

เอกสารอ้างอิง

  1. Bunik M. Breastfeeding telephone triage and advice. 2nd?ed. The American Academy of Pediatrics 2016.

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