Nipple Eczema and Breastfeeding: What You Need to Know

Sore nipples are common in the early days of breastfeeding, but ongoing nipple pain shouldn’t simply be accepted as part of breastfeeding.

Positioning and attachment are often the first things we think about when nipples are painful, but sometimes the problem is actually with the skin itself.

Eczema can affect the nipple and areola during breastfeeding, causing itching, burning, redness, dryness, flaking or cracking. And because some of these symptoms can look similar to other breastfeeding problems, getting the right diagnosis is important.

What does nipple eczema look and feel like?

Nipple eczema can affect the nipple, the areola (the darker area around the nipple) or the surrounding skin.

Symptoms can include:

• dry, flaky or scaly skin
• redness or a change in skin colour
• itching
• burning or soreness
• cracks in the skin
• weeping or crusting when the skin is particularly inflamed

Some women already have a history of eczema or sensitive skin, but nipple eczema can also appear during breastfeeding.

Why can eczema develop during breastfeeding?

Breastfeeding means the skin around the nipple is exposed to moisture and friction many times each day.

If the skin barrier becomes irritated, things that would normally cause little trouble may begin to aggravate it.

Possible irritants include soaps and shower gels, fragranced products, laundry detergents, fabric conditioners and breast pads.

Interestingly, products being used specifically to soothe sore nipples can sometimes be part of the problem. Certain creams or ointments may cause irritant or allergic contact dermatitis in susceptible skin.

If symptoms persist, it can therefore be useful to think not only about what you might need to put on the skin, but also what could potentially be irritating it.

Is it eczema or thrush?

This is an important question.

Burning, redness and persistent nipple pain have traditionally sometimes been attributed to nipple or breast thrush. However, several conditions can cause similar symptoms, including eczema and contact dermatitis.

That means repeatedly treating presumed thrush may not help if the underlying problem is actually inflammation of the skin.

A breastfeeding assessment can also be useful because nipple trauma from positioning and attachment, or the way a baby uses their mouth at the breast, may damage the skin and contribute to ongoing irritation.

Rather than trying one treatment after another, it is worth looking at the whole picture and establishing what is actually causing the pain.

How is nipple eczema treated?

Treatment will depend on how inflamed the skin is and what may be triggering it.

An important first step is often identifying and reducing potential irritants. Keep skin care simple, avoid unnecessary fragranced products and change damp breast pads regularly.

An appropriate emollient may be recommended to moisturise the skin and help restore its protective barrier.

When eczema is more inflamed, a healthcare professional may recommend a topical corticosteroid (steroid cream or ointment). Appropriate topical steroids can be used during breastfeeding.

If a preparation is being applied directly to the nipple or areola, ask your GP or pharmacist which product is suitable, when to apply it and whether it needs to be removed before your baby feeds.

Do I need to stop breastfeeding?

Usually, no.

Nipple eczema can generally be managed while you continue breastfeeding.

In fact, stopping breastfeeding unnecessarily may be the last thing you want when breastfeeding is otherwise going well.

Getting appropriate help early can make a considerable difference to your comfort and may prevent sore, inflamed skin becoming increasingly difficult to manage.

When should I seek medical advice?

Seek advice if your nipples are very painful, the skin is cracked, bleeding or weeping, you notice yellow crusting or other signs that could suggest infection, symptoms are becoming worse, or treatment isn't helping.

There is one particularly important point to remember.

Persistent skin changes affecting only one nipple, especially if they do not respond to appropriate treatment, should always be medically assessed rather than assumed to be eczema.

There are other, much less common conditions that can cause persistent eczema-like changes to the nipple, so an ongoing one-sided problem deserves proper assessment.

Nipple pain deserves attention

Breastfeeding can take a little time to establish, but persistent pain isn't something you simply have to put up with.

If your nipples are sore, itchy or irritated, looking at the skin is only one part of the picture. Positioning and attachment, nipple trauma, your baby's feeding and oral function, skin conditions and possible irritants can all be relevant.

Finding the cause means you can get the right treatment rather than continuing to try things that aren't helping.

Breastfeeding support in Jersey

If breastfeeding is painful or simply doesn't feel right, I can help you look at what is happening with both you and your baby.

As a Breastfeeding Coach and McTimoney Chiropractor, my approach is to look beyond the nipple alone, including positioning and attachment, how your baby is feeding and whether tension or restriction may be making feeding more difficult.

I offer breastfeeding support from my clinic in St Helier as well as breastfeeding and newborn home visits throughout Jersey.

You don't have to wait until breastfeeding has become really difficult before asking for help.

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