A breastfeeding woman is diagnosed with tinea corporis involving her chest, breasts, and abdomen. She would like to pursue treatment with both oral and topical medications and is wondering what oral medication would be safest for breastfeeding. She also asks you if she can continue to breastfeed her infant. What advice should you give this patient?

The American Academy of Pediatrics recommends exclusive breastfeeding for the first 6 months of life.1 Many women become discouraged when a clinician advises them to pump and dump or take a break from breastfeeding when taking certain medications or if they develop an infection.

Clinicians may not realize that any pauses in breastfeeding can dramatically decrease breastmilk supply. There are very few scenarios when a physician should discourage breastfeeding or advise a patient to discard expressed breastmilk. The case patient should be counseled about the contagious nature of tinea corporis. Specifically, she should be advised if the child’s scalp becomes infected (tinea capitis), the child will require systemic treatment. However, if the affected areas on the patient can be covered during breastfeeding to avoid skin-on-skin contact, the patient may decide to continue breastfeeding.

Oral fluconazole is considered safe during breastfeeding, and a 150 mg weekly dose for 2 to 4 weeks is an effective treatment for tinea corporis.2 Among other antifungal options, terbinafine has no significant data to assess potential risks to a breastfeeding infant or effects on milk production, and griseofulvin should be avoided as it is thought to be tumorigenic.3

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Paternalistic counseling styles should be avoided. Instead, discuss all treatment options, acknowledge that limited lactation data is available, and allow the patient to make the best decision for her and her child.

Nicole Papac, MD, is a dermatology resident at the University of Oklahoma Health Sciences Center, College of Medicine, Oklahoma City, Oklahoma; Ryan McIntire, BS, is a medical student at Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma.

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1. Meek JY, Noble L. Section on breastfeeding. Policy statement: breastfeeding and the use of human milk. Pediatrics. 2022;150(1):e2022057988. doi:10.1542/peds.2022-057988
2. Sahoo AK, Mahajan R. Management of tinea corporis, tinea cruris, and tinea pedis: a comprehensive review. Indian Dermatol Online J. 2016;7(2):77-86. doi:10.4103/2229-5178.178099
3. Prabhu SS, Sankineni P. Managing dermatophytoses in pregnancy, lactation, and children. Clin Derm Review. 2017;1(3):34.