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.
- 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 and Kelly Bonyata has some Healing Tips for Nipple Cracks or Abrasions.
Milk blisters or blebs
If thickened milk or a thin layer of skin blocks one of the openings of the nipple, 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. But if the bleb is stopping milk flow it can cause pain, often described as severe pinpoint pain, or be associated with engorgement or mastitis.
A bleb is a little white spot on the tip of a nipple that looks as if there’s milk stuck in a nipple pore. Maybe there’s a bit of skin over the surface of it, maybe not. Maybe there’s a plugged duct in your breast behind it, maybe not. but it can hurt when your baby nurses, like squeezing a pimple. Ow! 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.
The Womanly Art of Breastfeeding has lots of ideas to free the blockage including making the plug smaller with vinegar, softening the nipple pore, opening the skin over the pore and treating the plug higher up. The authors suggest washing once a day with soap and water and using a little antibiotic ointment for a few days may be helpful:
Make the plug smaller. Soak a cotton ball in vinegar and wear it over your nipple inside a bra. Milk has a lot of calcium in it, and vinegar dissolves calcium deposits.
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.
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.
Ideas for stubborn cases
- Topical steroid. Nipple blebs may be an inflammatory reaction to nipple damage in some women. In Are There Any Cures for Sore Nipples? Marsha Walker discusses a study that looked at blebs that didn’t respond to traditional treatment. In this study the author recommended a short course of a mid range topical steroid to penetrate into the inflamed tissue around the bleb 1.
- 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 treating a blocked duct.
- Lecithin. 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 as helpful for preventing recurring blocked ducts. 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)2.
- Cannulate the duct. 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).
White nipple spots that aren’t blebs?
There can be other causes of white spots on nipples including a build up of dead skin or a wound; for example saliva and milk moisture under the skin from baby biting the nipple3.
Thrush and white spots?
Occasionally thrush (a fungal infection) may look like little white blisters on the nipple. Check with your Health Professional and find further reading in our Thrush on Nipples article. Kelly Bonyata discusses how thrush can occasionally cause milk blisters in the following article:
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 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.
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.