When Sore Nipples Don’t Get Better

on May 30, 2014 in Breastfeeding, When Sore Nipples Don't Get Better

While many mothers suffer with sore nipples at the start of breastfeeding, some continue to have soreness past the early days of nursing.

Sore nipples are most common when the baby latches onto the breast in a position that is a bit off.  Even the slightest error in the latch can cause soreness and damage sensitive nipples.  For more information on the best way to position the baby at the breast, read the blog “Sore Nipples in the Early Days of Nursing”.

But when painful nipples continue, there can be other reasons causing this. For example, when a nipple is injured after the 5th day post partum, bacteria in the wound can keep the nipple from healing. Two Pediatricians who studied mothers with injured nipples, found that by taking antibiotics not only helped to heal the nipples, but prevented the mothers from developing mastitis.

Another remedy for long standing injured nipples is medical grade Manuka Honey. This honey is irradiated and contains no botulism spores. It is anti-microbial and anti-inflammatory as well. You can purchase a half ounce tube of this honey on line from a couple of different companies, including MediHoney from DermaSciences for about $10.00.

Some mothers develop a yeast infection on their nipples, but this is more likely the case of nipple sores after a few weeks of comfortable nursing. When yeast is the problem, usually the baby also is infected with thrush, yeast on the insides of the baby’s lips, cheeks, and tongue. If you suspect you may have a yeast infection, read the blog “The Yeast Beast” for more information and treatment measures.

There was a time in my early days of seeing breastfeeding mothers, when I saw many mothers with chronic sore nipples. For too long, I assumed that these pinkened nipples must be yeast. But I was wrong. Not all pink, sore nipples are caused by yeast.

I was very fortunate to have a mother come to me for breastfeeding help. She was a dermatologist. So after a time of seeing so many mothers with long standing sore nipples, which stumped me, I made arrangements for the dermatologist to see these puzzling cases. Her office got them in for an appointment quickly, she examined the nipples and prescribed a treatment. She also sent me a follow-up letter letting me know what she diagnosed as well as the treatment plan.

Some of the mothers seen by the dermatologist had underlying skin conditions such as eczema, impetigo, and psoriasis.  Many of the mothers had a dermatitis caused by certain irritants.  Eventually, we had the article we wrote published in the Journal of Human Lactation, “Twenty Cases of Persistent Sore Nipples; Collaboration Between Lactation Consultant and Dermatologist”.

For many of the mothers, the dermatologist used strong anti-inflammaotry ointments as she found that lower strength ones had little effect on many of the mothers who were bothered with pink, irritated nipples. Her ointment of choice was .5% triamcinolone, used sparingly after every other feeding or pumping, which is available only by prescription.

Now that the dermatologist has retired, when I see mothers with long standing irritated nipples, I suggest that the mothers call their OB or nurse Midwife for a prescription of this ointment.  While some mothers are able to get a prescription for this ointment, some doctors are concerned about using this strength and may call in a lower dose, like .1%.  But like the dermatologist found, these lower doses do little to help these pink, irritated nipples.

Some detergents may cause nipple irritation and painful feedings.  I do recommend that mothers who do not wear disposable pads, switch their detergents to on that is free from unnecessary dyes and fragrances.

If you find that your nipples are irritated and tender and are not responding to typical nipple ointments, like lanolin, you may want to get an appointment with a dermatologist. But with that being said, it can be very difficult to get a timely appointment with one as they are often very booked.  Also, they may not be familiar with treating chronic sore nipples.

Another possible remedy is one that comes from Dr, Jack Newman, a Canadian Pediatrician and lactation consultant.  He has come up with a prescription that is a mixture of topical medications to treat sore nipples.  It was developed to treat nipple soreness or injury stemming from any number of underlying causes including bacteria, yeast and inflammation.

This ointment needs to be ordered by a doctor or midwife and mixed by a pharmacist usually in a compounding pharmacy.  It contains the antibiotic, 2% Bactroban, which is helpful in destroying many bacteria, especially Staphylococcus aureus which is commonly found in injured nipples.  It may also have some effect effectiveness against yeast.  The second ingredient is 1% Betamethasone ointment, a corticosteroid which decreases inflammation.  It is well absorbed into the skin and the baby will not take in very much at all.  The final ingredient is 2 or 3% Miconazole powder, an effective ingredient against yeast, Candida albi-    cans.  Miconazole cream or gel should not be used in this mixture as this can cause separation of the mixture.

Dr. Newman writes the prescription this way;

1.  Mupirocin ointment 2%: 15 grams

2.  Betamethasone ointment 0.1%: 15 grams

3.  To which is added miconazole powder to a concentration of 2% miconazole

Total: about 30 grams combined.  The mixture is to be used sparingly after each feeding and not wiped or washed off prior to nursings, although rinsing both nipples after nursing and before applying the ointment is still recommended by lactation consultants.