I googled for photos of eczema and found this site:
Wait, what?!This is what my nipples look like most of the time. I assume thrush, treat for thrush and hit or miss it goes away within 24-48 hours. Or do I just think it's thrush and really it's some sort of allergic reaction and it goes away after the food is out of my system? I never knew you could get eczema on your nips! And I can't find a single pic of a thrush nipple on the internet...
When I'm having a "thrush outbreak" my nips look like 11, 14, or 17 most times.
This is one of those detective things. Even a well-trained LC will have trouble immediately identifying if a rash like that is the result of thrush, allergies, or eczema. Poison ivy on the nipple even looks the same so...it may help to take a holistic view. If it is eczema chances are high that you have had eczema on other parts of your body. If this is the case, and you can get clearance from your dr and LC then try your normal topical cream on your nipples and see if the rash goes away this way as well. If you have no history, then this is most likely not the case. If it is an allergy chances are high that it is a skin allergy rather than a dietary one (as dietary would also show up in other areas) so you may consider if you're using any nipple creams (lanolin has wool, etc) and if you react after using them (also consider if it's a pumping issue and you develop this only after pumping) And finally, if those aren't the case then you're back at yeast..which looks the same. You already probably know that antibiotics, breastpads, and a baby with thrush are all things that increase your chance of recurrence. Good luck in finding what works best for you!
I agree, it is difficult to differentiate rashes, especially on the nipple. There isn't a sure-fire way to diagnose them based on looks alone. Most likely it's yeast/thrush, and sometimes that requires persistent, thorough and systemic treatment before you'll see any results (not in 24-48 hours in other words.)