Treatments for Sore Nipples

Breastfeeding isn’t supposed to hurt but if a baby isn’t latched properly, or isn’t using his tongue correctly, nipples can quickly become painfully sore. Once a baby is able to latch deeply, sore nipples caused by poor positioning or attachment usually heal quickly on their own. However, sometimes finding the causes of sore nipples is not easy and takes some time, and meanwhile sore nipples are a high risk factor for stopping breastfeeding early. Are there any treatments to soothe sore nipples? This article discusses popular treatments for sore nipples from prescription medication to home remedies.

Treatments for sore nipples

There are many possible treatments for sore nipples from lanolin to prescription ointments to nipple shields and more. Choosing the right treatment for your sore nipples will depend on whether you are tackling inflammation, broken skin or an infection. If you have cracked, blistered or damaged nipples there is a higher chance of a bacterial (e.g. staph) or fungal infection (e.g. thrush) on your nipples which may require medication from your doctor. Sore nipples can also be due to eczema, or psoriasis or caused by an allergy to a treatment you have already been using. Always check with your health professional if you have very sore nipples that are not healing.

#1 Identify the cause of sore nipples

Try to work out what is making your nipples sore with the help of your IBCLC lactation consultant and health care professional. Correct the latch if soreness is caused by poor attachment during breastfeeding or check Causes of Sore Nipples for other causes.

#2 A medical based treatment plan

In Are There Any Cures for Sore Nipples? Marsha Walker IBCLC compared various sore nipple treatments and concluded that many ‘alternative treatments’ do not have very good evidence for their use. She favours the following medical based treatment plan for cracked or damaged sore nipples:

  • Correct positioning and latch
  • If there is broken skin; wash nipples daily with soap and water and apply a topical antibiotic (mupirocin) to treat any bacterial infection such as Staphylococcus aureus and a topical low strength steroid for inflammation. Avoid using a dummy (pacifier), if used wash thoroughly with soap and water.
  • If there is a fluid discharge or pus or very red skin without a dry scab; take antibiotics. If thrush (C. albicans) is a possibility, add an anti fungal agent (topical 2% miconazole).
  • If the infection doesn’t respond to the above; treat the baby with nasal mupirocin because he may be a carrier of the bacteria Staphylococcus aureus and may infect or reinfect the mother’s nipple 1. And test for small colony variants of staphylococci (bacteria); if they are present use the appropriate antibiotics (macrolide therapy), be vigilant for mastitis and check for anaemia.

All purpose nipple ointment

Well known Canadian paediatrician and breastfeeding specialist Jack Newman has a similar protocol for sore nipples with his All Purpose Nipple Ointment (APNO) which contains a topical antibiotic, anti inflammatory and anti fungal in one treatment. In this article Dr Newman describes the concentration of each ingredient in the cream and signposts you to a website that lists compounding pharmacies in Canada and US who can make it up. Although APNO may not be available in your area or country, you may wish to discuss with your doctor whether a similar combination treatment may be appropriate in your situation.

#3 Wash with plain soap

Washing damaged nipples with ordinary mild soap (not antibacterial) keeps the wound clean, reduces the number of bacteria present and breaks down the bacteria’s protective shield. This shield (biofilm) protects the bacteria from the mother’s immune system and from antibiotic treatment. With the shield disrupted, topical antibiotic can better reach the affected area.  Note; there’s no need to wash healthy nipples with soap. (Walker, 2013)

#4 Moist wound healing

Purified lanolin

A very thin layer of the right product may provide a protective barrier to the skin allowing damaged nipples to heal in a process called “moist wound healing”. One such product that some mothers find helpful is purified lanolin—extracted from sheep’s wool—however some may find they react to it making their sore nipples worse.

Ultra purified lanolin has had wool alcohols and detergent and pesticide residues removed, and only the smallest smear is necessary.

Purified lanolin is for nipples what lip balm is for lips. It helps keep the cells’ own moisture intact. A healthy nipple doesn’t need ointment, but if your nipple is chapped or slightly damaged a light coating of purified (to reduce the risk of allergies) lanolin keeps newly formed cells from drying out and allows them to slide easily across the damaged area to bridge the gap more quickly. This “moist wound healing” can be very effective but only if you address what caused the damage in the first place.

Note: Frequent use of lanolin on nipples may increase the risk of nipple infections, particularly fungal infections such as thrush. Sasaki et al call for more research to establish whether lanolin is a growth medium for thrush particularly if the mother has a history of antibiotic use during childbirth 2.

Hydrogel dressings

Commercially made hydrogel dressings have a high water content which can cool a wound and provide a moist healing environment, they are applied between feeds:

These dressings are water based and often a combination of water and glycerin in a polymer matrix. Their value lies in their ability to maintain moisture, inhibit scab or crust formation, reduce pain, and enhance epithelial migration for wound repair.

Hydrogel dressings may be a possible option in the treatment of nipples with open sores or cracks with exudate. The dressing absorbs wound discharge and prevents the nipple skin from adhering to the mother’s bra.

#4 Home remedies

The following are some popular remedies for sore nipples. However, there is little evidence or proof of how effective they really are and any individual product may cause allergic symptoms for a particular mother:

Breast milk is a popular choice often suggested for rubbing into sore nipples to aid healing. Breast milk is full of anti infective factors that can combat bacteria. However if breast milk contains allergens that the mother is sensitive to, it may not be so calming.

Warm water compresses were shown in one study to be more effective at soothing sore nipples than lanolin or breast milk 3

Commercial nipple creams used routinely may alter the pH of the nipple and areola or block the Montgomery glands—reducing both the natural protective factors in the areola and the odours that guide baby to latch to the nipple 4 5. In addition, it is not always clear whether commercial creams with multiple ingredients are safe for mother and baby (Walker, 2013).

The nipple and areola do not require creams and lotions because these substances will reduce the amount of air circulation to the skin, and secretions from the Montgomery glands may provide the baby with a smell aiding in nipple location.

Virgin coconut oil is said to have antibacterial, anti fungal, anti inflammatory and an analgesic effect 6 7 8. On the safety of virgin coconut oil, Thomas Hale breastfeeding and medications author writes on a forum:

Coconut oil, commonly called MCT oil (medium chain triglyceride), is commonly used in our NICUs to add fat into the diet of premature infants. It consists primarily of 6-12 carbon atom free fatty acid triglycerides which are easily digested by all neonates and older children. It is an ideal triglyceride for infants.

As a pure oil, it has virtually no allergenic compounds. So, if you use a high grade Coconut oil, I would not be worried about its use at all, or worry about allergies.

That said, I don’t see how it would be any better as an emollient than lanolin.

Note: As with all substances applied to nipples, some mothers or babies may be sensitive or allergic to coconut oil.

Medihoney is said to penetrate biofilms and be antibacterial, including against methicillin resistant Staphylococcus aureus (MRSA). Medihoney is not the usual food grade honey it is a medical grade honey product made from Leptospermum plant species. Botulism spores may be present in normal honey and honey is not recommended for babies under 12 months of age. Marsha Walker IBCLC reports that anecdotally Medihoney is thought helpful for healing sore nipples and states that it has been treated to remove botulism spores 9. However check with your health professional on the advisability of using this product if you have a baby younger than 12 months.

#5 Nipple shields

Although not a treatment or cure as such, modern silicone nipple shields can be helpful in relieving the pain of sore nipples by protecting the nipple. This may make it bearable for a mother to continue breastfeeding while she seeks specialist help with positioning or while her nipples heal. Nipple shields also have a place as a suck training tool in certain situations e.g. for babies who are retracting their tongues. For more information see Nipple Shields Good or Bad?

#6 Special cases

Eczema, dermatitis and psoriasis

Other causes of sore nipples include the skin conditions; eczema, dermatitis and psoriasis. Contact your health professional for diagnosis and medication compatible with breastfeeding. Dr Lisa Amir discusses treatment in Managing Common Breastfeeding Problems in the Community, BMJ, 2014. She explains that eczema or dermatitis is diagnosed when the symptoms include pain and itching with reddening of the skin (erythema) which is often clearly marked, and sometimes with flaking (may indicate psoriasis) or crusting (may indicate colonisation by bacteria e.g. Staphylococcus aureus (S.aureus).

The condition may be atopic in susceptible women, or may be secondary to topical creams or devices such as breast pumps.Psoriasis should be considered when flaking is prominent. Treatment includes application of a moderately strong corticosteroid, such as mometasone, once daily and sparingly after a feed (no need to be washed off) for up to 10 days. When crusting is a feature, the dermatitis is likely to be colonised with S aureus, and mupirocin ointment can be added.

The latest recommendations for compatibility of medications for breastfeeding mothers can be found in Medications & Mothers’ Milk by Thomas Hale. The article Medications and Breastfeeding lists several online resources for checking medications which can be shared with your health professional.

Allergens

Sometimes sore nipples, eczema or dermatitis are perpetuated by an allergy to a product a mother is using. Even purified lanolin can cause a reaction for some mothers.

Paget’s disease (rare)

Paget’s disease of the nipple is a skin condition that looks like eczema or psoriasis with flaking skin or itching, but is due to an underlying cancer. It is usually confined to one breast and is diagnosed by nipple biopsy if a week of steroid treatment doesn’t rapidly improve the condition.

It is quite uncommon in women of childbearing age but it can occur. Paget’s disease is easily mistaken for eczema because of the flaking skin and itching. Most mothers with eczema get it on both breasts, though, while Paget’s disease usually involves only one. If treatment with a steroid ointment does not result in rapid resolution (within a week) of the problem, the mother should see her doctor. The diagnosis is made by biopsy of the nipple. This does not mean the mother should stop breastfeeding on that side—she cannot transfer cancer to the baby by breastfeeding.

Summary

The most common cause of sore nipples while breastfeeding is when a baby is not latched correctly. Once the latch is improved, sore nipples will quickly heal on their own. However if the problem continues, nipples can soon become painfully cracked and have a higher risk of infection. There are many treatments for sore nipples available but they can vary widely in how effective they are and some remedies may even be part of the problem. There is currently not enough evidence to recommend one treatment over another 10. Contact your IBCLC lactation consultant and health care provider with ongoing sore nipples so that you can get the best breastfeeding help and correct treatment.

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