Moist-wound healing for nipple damage

Why should I keep my nipple damage moist?

Skin damage heals faster when kept moist. If a damaged area is exposed to air and dries, it usually forms a scab, which then shrinks and pulls on the skin around it. Under this hard, inflexible scab, the skin is rebuilt as skin cells move onto the damaged area from underlying hair and sweat glands and from the healthy skin surrounding it. The scab, however, is thought to be a barrier to the movement of these cells. Keeping the skin moist means a scab will not form. Wound care products and covers can be used to keep the damage moist. Mothers who have nipple damage should not allow air to contact the nipple until it is totally healed. The underlying cause must also be addressed to speed healing and prevent further damage.

A) Research on the best way to heal nipple damage is limited

More than 30 treatments have been reported for sore nipples, but there is very little conclusive research on the best way to heal nipple damage (Dennis 2014; Morland-Schultz 2005; Vieira 2013; Walker 2013).

There is, however, a large amount of research about healing skin damage on other parts of the body. The nipple is covered in skin, so that research can be applied to healing nipples (Leaper 2012). 

The cause of the nipple damage, whether it has developed soon after breastfeeding starts (early-onset) or after a period of pain-free breastfeeding (late-onset), should also be addressed. 

B) When wounds are exposed to air

Without treatment, most skin damage exposed to air form scabs and heals in the following way:

  1. The body creates a hard, inflexible crust (scab) to cover the damaged area.
  2. The scab shrinks and pulls on the skin around it, creating tension in both.
  3. Under the scab, the damaged area is re-covered by skin cells that come from:
    1. Healthy skin at the edge of the damaged area.
    2. Hair follicles and sweat glands (if the damage is not too deep).
  4. Once the damage is healed, the scab falls off.

The human nipple does not have hair follicles but does have sweat glands.

C) Reasons for moist-wound healing

Air-drying used to be a common way to treat nipple damage. However it can delay healing and increase pain.

In the early 1960s, researchers discovered that damaged skin heals much faster when it is kept moist, not too wet and not too dry, and when scabs are not allowed to form (Hinman 1963; Winter 1962). There are several reasons for this (Ousey 2016; Ruthenborg 2014): 

  • It has been found that without a scab and with the right amount of moisture, skin cells move more easily from healthy tissue around and below the area of damage onto the surface of the damaged area.
  • Damaged skin that is kept moist stays supple and relaxed and does not shrink. The decrease in tension in the damaged area and the skin around it may also speed the healing.
  • Covering damage with moisture may create a low-oxygen environment that helps damaged skin heal faster.

D) Applying wound care theory to nipple damage

Dry scabbed nipple wound (ulcer) (Stage 3 damage). Breastfeeding is extremely painful.

Both superficial and deep damage (Stages 2 and 3) of the nipple tend to be dry and tend to form scabs when exposed to air. Based on wound-care research, they should heal faster when treated with moisture from wound care products and from covers.

This has been our experience. We have cared for many mothers with nipple damage. Some were air-drying painful, unchanging, open wounds for weeks. Remarkably, within one to two weeks of starting proper care, the wounds healed. 

If you have nipple damage, you should not allow air to contact the nipple until it is totally healed. If you do, the healing will take longer and the process will be more painful. Rather wound care products should be applied right after the baby lets go of the breast.

Moist-wound healing is used for both early-onset and late-onset nipple damage.

References

Dennis CL, Jackson K, Watson J. Interventions for treating painful nipples among breastfeeding women. Cochrane Database Syst Rev. 2014 Dec 15;(12):CD007366
 
Hinman CD, Maibach H. Effect of air exposure and occlusion on experimental human skin wounds. Nature. 1963 Oct 26;200:377-8
 
Leaper DJ, Schultz G, Carville K, et al. Extending the TIME concept: what have we learned in the past 10 years? Int Wound J. 2012 Dec;9 Suppl 2:1-19
 
Morland-Schultz K, Hill PD. Prevention of and therapies for nipple pain: a systematic review. J Obstet Gynecol Neonatal Nurs. 2005 Jul-Aug;34(4):428-37

Ousey K, Cutting KF, Rogers AA, et al. The importance of hydration in wound healing: reinvigorating the clinical perspective. J Wound Care. 2016 Mar;25(3):122, 124-30
 
Ruthenborg RJ, Ban JJ, Wazir A, et al. Regulation of wound healing and fibrosis by hypoxia and hypoxia-inducible factor-1. Mol Cells. 2014;37(9):637-43
 
Vieira F, Bachion MM, Mota DD, et al. A systematic review of the interventions for nipple trauma in breastfeeding mothers. J Nurs Scholarsh. 2013 Jun;45(2):116-25
 
Walker M. 2013 Are there any cures for sore nipples? United States Lactation Consultant Association Clinical Lactation, 2013; 4(3)
 
Winter GD. Formation of the scab and the rate of epithelization of superficial wounds in the skin of the young domestic pig. Nature. 1962 Jan 20;193:293-4