Treating milk pimples

How do I treat a milk pimple?

Milk pimples heal on their own, but it can take up to eight weeks. There are a number of treatment options but very little research on which are best. If the pimple is new, small, looks like a pimple, and is above the surface of the nipple, mothers may be able to open it and remove the contents. After this, the pain settles quickly. This is done with a pair of sterilized tweezers. To support healing, purified lanolin should be applied after each feeding and covered with a non-stick dressing. Another way to open a pimple is with a sterile needle, but this can be both more painful and more dangerous. If the pimple is old, big, or deep, mothers can use a mid-strength steroid ointment for 7 to 10 days to decrease the pain and inflammation. This needs to be wiped off before breastfeeding. Milk pimples can be opened with a scalpel, injected with steroid medication, or if the breast milk shows signs of infection, be treated with antibiotics. 

A) Milk pimple pain

Milk pimples, also known as blebs, can be mildly painful but can also cause severe latching pain and pain throughout the feed. Milk pimples gradually disappear without treatment as the body absorbs them, but it can take up to eight weeks. They are most painful in the two weeks after they appear.

The degree of pain, their size, and age will influence how they are treated.

Milk pimples tend to recur but there ways to help prevent them.

Health-care providers can be helpful if the pimple does not settle. 

B) Letting the pimple heal itself

The body will work to remove milk pimples. If mothers find the pain tolerable and it is steadily improving and they do not have a plugged duct, mothers can simply leave the pimple alone.

C) Opening the pimple

New milk pimple. The edges are sharp.

A pimple can usually be opened if it:

  • Is new.
  • Looks like a pimple.
  • Is less than 2 mm in width.
  • Is at or above the surface of the nipple.

Once it turns yellow and the edges are no longer sharp, there is usually no point in opening it as the pimple is being absorbed into the body. The milk and cheese-like filling is being replaced with blood vessels and normal tissue.

When new pimples are opened and the contents are removed, the pain quickly settles. Milk pimples can also cause plugged ducts. In this case, the milk pimple may need to be opened to clear the plug.

Here is one way to open milk pimples:

  1. Wash your hands.
  2. Wash a pair of tweezers.
  3. Sterilize the tweezers by putting them in boiling water for five minutes and then allow them to cool on a clean dry towel.
  4. After the baby has breastfed, try to pick off the top layer of skin with the tweezers.
  5. This may need to be done after several feeds.
  6. Try to push out the contents using clean fingers. Sometimes the pimple needs to be massaged or squeezed a little to get it to empty.
  7. Purified lanolin should be applied to the site after each feeding and covered with a non-stick dressing until it is healed.

Another way to open a pimple is to use a sterile needle, but many mothers tell us this hurts a lot. It can also be more dangerous as the needle is sharp and can penetrate deeper into the nipple. A health-care provider may assist you with this.

Repeatedly opening milk pimples can result in inflammation, scabbing, scarring, or infection and should be avoided.

D) Steroid ointment

Older milk pimple. The edges are not sharp.

Some milk pimples are too old, big, or deep to be opened. They may:

  • Be difficult to open.
  • Be older and have become more yellow and thickened with blurred edges.
  • Be large.
  • Be deep below the nipple surface.

In these cases, we have found that using a mid-strength steroid ointment for 7 to 10 days helps to speed healing and decrease pain (Tait 2000). Steroid ointments may work in the following ways:

  • They can thin the skin overlying the blister, allowing it to open more easily.
  • They can decrease swelling of the opening of the duct which may treat or prevent blocked ducts.
  • They can decrease inflammation and pain.

We prefer ointments over creams. Ointments are better able to penetrate skin and deliver the steroid to the problem area. These must be obtained by prescription from your health-care providers.

If you are using a mid-strength steroid ointment:

  1. Right before breastfeeding, wash the ointment off, using breast milk and a soft, clean cloth.
  2. Breastfeed the baby.
  3. Apply a very small amount of ointment directly to the pimple with a very small applicator, such as a toothpick.
  4. Do not apply the ointment to the healthy part of the nipple.
  5. Cover the ointment with a non-stick dressing to keep it from being wiped off.
  6. When the baby is hungry, return to step 1.

Do this for 7 to 10 days, not longer.

It is very important that you wash off the ointment before breastfeeding and that you don’t use if for more than 10 days. Steroid ointments need to be treated with respect as they can have significant side-effects for both mother and baby.

E) Cutting the pimple open

If the pimple doesn’t settle with either opening the pimple with tweezers or steroid cream use and is still very painful, it may benefit from being opened with a scalpel. It can hurt at the time, but it may be the only way to settle a bad one (O’Hara 2012). This would be done by a health-care provider with relevant surgical experience.

Larger, deeper milk pimples may actually be fluid-filled sacs (cysts). These are unlikely to clear up on their own and may need to be cut open if they are causing persistent or severe pain. Please discuss this with your health-care providers.

F) Steroid injections

Persistent, painful, and large pimples may benefit from a steroid injection (Mitchell and Johnson 2020).

G) Antibiotics

There is one report (Mitchell 2020) of a mother who had a rapid onset of pain in one part of the breast, a milk pimple, and plugging. Her milk was tested and found to contain a type of bacteria that was resistant to a number of antibiotics. She was diagnosed with subacute mastitis and treated with antibiotics given through a vein (IV). Her problems cleared eight weeks later.

H) Infection after treatment

In rare cases after a pimple is opened or breaks open on its own, the wound becomes infected. The infection is treated with an antibiotic.

If the pain is not too severe and there is no sign of mastitis, antibiotic ointments can be used. If the pain is severe, there is mastitis, or the nipple did not improve with an antibiotic ointment, oral antibiotics should be used.

References

Mitchell KB, Johnson HM. Breast Pathology That Contributes to Dysfunction of Human Lactation: a Spotlight on Nipple Blebs. J Mammary Gland Biol Neoplasia. 2020;10.1007/s10911-020-09450-7

O'Hara M-A.  Bleb histology reveals inflammatory infiltrate that regresses with topical steroids; a case series [platform abstract]. Breastfeed Med 2012;7(Suppl 1):S-2
 
Tait P. Nipple pain in breastfeeding women: causes, treatment, and prevention strategies. J Midwifery Womens Health. 2000 May-Jun;45(3):212-5