A mother may sometimes notice blisters or white spots on her nipples during breastfeeding. Friction blisters and blocked nipple pores (milk blisters or blebs) are the most common causes. This article discusses the types of blisters or white spots on nipples that a breastfeeding mother may encounter and gives ideas to avoid or resolve them. Contacting your health professional will help confirm the cause of the white spot or blister if you are not sure.
A clear blister or red/brown “blood blister” on the nipple is usually caused by friction or high vacuum just like a blister anywhere else on the body. Possible reasons for friction blisters on nipples include:
- A shallow latch. If a baby is not attached (latched) deeply on the breast with plenty of breast tissue in their mouth as well as the nipple it is called a “shallow latch”. If a baby is in a shallow latch, there is more chance for the mother’s nipple to rub against the roof of her baby’s mouth and cause a blister at the point of contact. See our articles Breastfeeding Positions for Newborns and Latching Tips for help to improve your baby’s positioning and attachment, or find a breastfeeding expert to help you.
- A poorly fitted nipple shield or pump flange. Blisters on nipples may also form from a badly fitted nipple shield or pump. For information about getting a good fit on a pump flange see How to Increase Milk Supply When Pumping and for more information about choosing a nipple shield see Nipple Shields Good or Bad?
- Differences in anatomy preventing a deep latch. Individual anatomy such as a larger nipple, flat nipple or a baby with a small mouth or restricted tongue function can make it more difficult for a baby to get a deeper more comfortable latch and blisters may be more likely.
Once the source of the friction has been found and corrected, blisters should quickly heal on their own. If a blister bursts before it has healed beneath and you have sore broken skin on your nipple check out Treatments for Sore Nipples.
Milk blisters or blebs
If thickened milk or a thin layer of skin blocks one of the openings of the nipple (nipple pores), it may cause a white spot on the nipple. This is often called a bleb or milk blister. A bleb that doesn’t hurt may disappear on its own in a few weeks or months. However, if the bleb is stopping milk flow from the affected nipple pore, it may cause severe pinpoint pain during breastfeeding.1 A blocked nipple pore can be associated with a blocked milk duct behind it which could lead to engorgement or mastitis.2
Inflammatory response or pressure cyst
Some authors propose that when milk in the nipple pore is sealed over by a layer of skin, an inflammatory response causes the tender spot or bleb which could be white or yellow depending how long it has been there.3 4 Another theory from authors Lawrence and Lawrence is that a bleb could be a small pressure cyst at the end of a milk duct due to milk seeping into the elastic tissue.(Lawrence, 2016, p270). A recent paper notes that blebs are seen at the same time as hyperlactation (when the body produces more milk than baby needs) and subacute mastitis (mammary dysbiosis) (Mitchell and Johnson, 2020).
Ideas to treat a bleb
There are a a number of suggested ways to try to release a bleb and provide pain relief, prevent infection and reduce inflammation. Some require the help of a health professional and some can be tried at home. When the bleb is released, little granules or a string of thickened milk might be seen. The Womanly Art of Breastfeeding explains:
When you get rid of a a bleb, the contents may come out as little granules that you can feel between your fingers, or as a tiny ribbon like toothpaste. Or it may just disappear during a nursing (going harmlessly into the baby). Once it’s gone, any backed-up milk generally clears quickly.
#1 A warm compress
A warm compress on the nipple or soaking the nipple in warm water can soften the skin around the plug which can help to release it (ABM Clinical Protocol #30, 2019). Rubbing the nipple with a damp cloth after soaking and before trying to express the plug can remove any skin layers over the pore to help with the release (Wambach and Spencer, 2021. p295). The Womanly Art of Breastfeeding also suggests using olive oil to soften the bleb:
Make the nipple pore softer. Soak in the tub or shower, then soak a cotton ball in water, olive oil, or canola oil (corn or peanut oil could encourage allergies) and wear it in your bra over your nipple. Putting some gentle heat over the cotton ball—a sock filled with rice and heated in the microwave, for instance—may help. Or soak your nipple in a cup of warm water to which you’ve added 2 teaspoons (10g) of Epsom salts. Then see if nursing, gentle manipulation, or pressure from behind will squeeze the thickened milk out.
#2 Make the plug smaller
Vinegar may help to dissolve calcium deposits in the milky contents of the bleb to reduce its size. The authors of The Womanly Art of Breastfeeding suggest wearing a cotton wool ball soaked in vinegar over your nipple inside a bra cup to achieve this (WAB, 2010).
#3 Open the skin
Carefully breaking the skin that may have grown over the nipple pore can provide relief and allow the bleb to be released. It is very important that any implements such as a needle or tweezers used to carefully break the top layer of skin are sterile to prevent introducing an infection. Some resources recommend this is only done by a health care professional.5
The Womanly Art of Breastfeeding describes the technique:
Open the skin over the pore. You can ask your health care provider to open it gently with a sterile needle, or do it yourself with a well-sterilised (in a candle flame, for instance) needle. Pick carefully at it from the side; that top layer of skin should have no feeling in it, but the skin underneath may be sensitive. You can use sterile tweezers to peel back any tiny flaps of skin that cover the opening. Manipulate your nipple or have your baby nurse to remove the bleb.
Caution: It is not recommended to repeatedly try to free a bleb in this way. Authors Mitchell and Johnson explain that blebs may bleed, scab or become scarred with a raised scar (hypertrophic scar) with repeated opening of the skin and this is not an effective management strategy (Mitchell and Johnson, 2020).
#4 Prevent infection
Once a bleb has been opened it is important to prevent infection. Several authors recommend washing the nipple once a day with a mild soap and water and/or using a little antibiotic ointment after feeds (Mohrbacher, 2020 p 735; Womanly Art, 2010 p 377/8).
#5 Topical steroid
Nipple blebs may be an inflammatory reaction to nipple trauma6 or an inflammatory response to milk in a nipple pore sealed over by skin (Wambach and Spencer, 2021. p 295). One study recommended a short course of a mid range topical steroid to penetrate into the inflamed tissue around the bleb.7 The ABM Protocol also recommends steroid cream for persistent blebs (ABM, 2019).
#6 Treat an associated blocked duct
Sometimes the cause of the nipple bleb could be associated with a blocked duct deeper in the breast see Blocked Milk Duct for ideas for several ideas and massage techniques for treating a blocked duct including the six step recanalization manual therapy (SSRMT) which involves checking for blocked nipple pores. If blocked ducts are associated with excess milk production steps can also be taken to reduce engorgement or consider management strategies to regulate the milk supply see Oversupply of Breast Milk on this website.
#7 Lecithin for recurring blebs
Lecithin is a type of fat found in some food and human cells and is available as a food supplement. Lecithin taken as a supplement is sometimes suggested for preventing recurring blocked ducts. As blebs are frequently associated with blocked ducts deeper in the breast, taking a daily lecithin supplement can often be helpful. Mitchell and Johnson cite taking lecithin orally and applying topical steroid treatment to the bleb as a promising and effective strategy for single (unifocal) blebs (Mitchell and Johnson, 2020). In Breastfeeding A Guide for the Medical Profession Lawrence and Lawrence discuss that if gently opening the blocked nipple duct with a sterile needle has not worked, rubbing lecithin into the nipple after each feed may be helpful for a nipple duct that is clearly blocked. Lawrence comments that lecithin can also be helpful if the cause of the white spot is a build up of cells such as with seborrhoea dermatitis (or cradle cap).8
#8 Cannulate the duct
Authors Lawrence and Lawrence refer to the possibility of cannulating the duct with a strand of surgical thread in a doctor’s surgery i.e. inserting the thread up the duct until the plug is released (Lawrence, p. 270).
#9 Imaging may be warranted
If blebs are very persistent causing blocked ducts and mass-like obstruction, Mitchell et al suggest further medical investigation may be necessary.9
#10 Other treatments
Sometimes what might have started out as a bleb may have developed into something else or perhaps it was a symptom of another issue and a different or additional treatment may be needed. Repeatedly opening a bleb may inadvertently introduce a bacterial or fungal infection; or trying different topical over-the-counter ointments to provide pain relief could introduce an allergy or contact dermatitis.
Subacute mastitis may encourage blocked ducts and blocked nipple pores and in these cases antibiotics may be helpful (Mitchell and Johnson, 2020). Blebs associated with acute or subacute mastitis can take longer to resolve (Mitchell and Johnson, 2020). One case report described a mother with subacute mastitis associated with nipple blebs and persistent blocked ducts. The mother’s milk tested positive for MRSA (methicillin-resistant Staphylococcus aureus) and treatment for an MRSA infection resolved all issues.10
White nipple spots that aren’t blebs
Dead skin or a wound
There can be other causes of white spots on nipples including a build up of dead skin cells such as seborrheic dermatitis or cradle cap.1112 Or a wound; for example saliva and milk moisture under the skin from baby biting the nipple13.
Thrush and white spots?
Occasionally thrush (a fungal infection) may look like little blisters on the nipple (Wambach and Spencer, 2021 p 290) or it may look like white patches similar to oral thrush (Lawrence, 2016. p 270). Check with your health professional and find further reading in our Thrush on Nipples article. Kelly Bonyata explains:
Thrush (yeast), can also cause milk blisters. Thrush occasionally appears as tiny white spots on the nipple, but can also appear as larger white spots that block one or more milk ducts. If you have more than one blister at the same time, suspect thrush as the cause. Yeast is often accompanied by a “burning” pain, and the pain tends to be worse after nursing or pumping (whereas a plugged duct generally feels better after the breast has been emptied).
Herpes simplex viruses 1 (cold sores) and 2 (genital herpes)
Herpes could cause blisters on the nipple. Symptoms of herpes include small, painful, fluid filled, red-rimmed blisters containing viral material that dry after a few days and form a scab. As these viruses are spread by simply touching the sores, it is very important that your baby doesn’t come into contact with them. Observe careful hygiene to protect your baby. Lesions can appear anywhere on the body including the breast e.g. genital herpes sores can be spread by touching the sores and then touching the breast. If the sores (blisters) are on your nipple or close by your nipple this will mean avoiding breastfeeding from that breast until they heal. For more information see Herpes and Breastfeeding.
A white tip to the nipple directly after a breastfeed which goes away between feeds could be a nipple vasospasm. A nipple vasospasm can be triggered by a breastfeeding baby who is pinching the nipples but it can also be connected with Raynaud’s phenomenon (a condition affecting blood supply). The white spot indicates an area where the blood has been squeezed out of that part of the nipple which returns to normal colour when the blood flows back in. For more information see Nipple Vasospasm and Breastfeeding.
Blisters on nipples or white spots on nipples during breastfeeding can have a number of causes. A regular friction blister may be caused by a poorly fitted nipple shield or pump flange or if the nipple is rubbing inside baby’s mouth (usually due to a shallow latch). White spots on nipples may be due to thickened milk or a thin layer of skin blocking a nipple pore—often called a bleb or milk blister. A thrush infection or the herpes virus are also possible causes of blisters on nipples. Your health professional will help diagnosis the nature of a white spot or blister and your breastfeeding expert can offer ideas to avoid them in future if they are caused by positioning or breastfeeding gadgets. For more possible reasons for sore nipples see Causes of Sore Nipples.