Nipple ointment and other wound-care products

What should I put on my nipple damage?

There are a number of appropriate products (wound care products) that encourage nipple damage to heal. Purified lanolin marketed for breastfeeding is most commonly used for nipple damage. Hydrogel dressings are another option. When nipple damage becomes infected, antibiotic ointments may be used. Medical grade honey can also be used to both prevent and treat infection. These products need a cover to keep them in place. Wound care products are products are for nipples that have skin damage; they are not helpful for nipples that are painful but intact.

A) Describing wound care products

Wound care products are used to provide moisture which speed wound healing and decrease pain. 

1) Criteria for choosing a wound care product

Many wound care products are available to heal wounds on other parts of the body but are not appropriate for use by a breastfeeding mother. Products used on the nipple must:

  • Be removable for every breastfeeding or expression session.
  • Not cause further pain or damage.  
  • Not cause an allergic reaction. 
  • Be safe for the baby and not inappropriate or dangerous.  

Wound care products are applied right after the baby lets go of the breast or the mother has finished expressing as skin damage should not be air-dried. These products may need a cover to keep them in place and make them effective.

Mothers who do not have nipple pain or damage do not need any products. 

2)  The best options

There is only a small amount of research about which wound care products are best to treat nipple damage (Dennis 2014; Morland-Schultz 2005). 

The wound care products described below allow for moist-wound healing and are appropriate choices. 

If you have nipple damage, please see your health-care providers. 

B) Purified lanolin

Purified lanolin.

1) Describing purified lanolin

Purified lanolin marketed for breastfeeding is the most commonly-used product for the treatment of nipple damage. It is cheap, commonly available, and easy to apply. 

Purified lanolin is a thick, firm, slightly yellow ointment. It is made from fatty acids found in sheep wool grease and it appears that babies can digest it without harm. It does not need to be washed off before breastfeeding or expressing.

Purified lanolin is not the same as regular lanolin, which contains pesticides and has a higher chance of causing allergic reactions.

Two common brands of purified lanolin are Lansinoh™ and Purelan™. 

2) Using purified lanolin

To use purified lanolin:

  1. Start right after each feeding and do not allow the nipple to dry.
  2. Apply the purified lanolin to the damaged area with a clean finger or a cotton swab.
  3. Use only enough purified lanolin to cover the damaged area. Keeping normal skin too moist can increase the risk of skin breakdown and yeast infections.
  4. Purified lanolin should be kept in place with a cover.

Out of 14,000 patients, we have cared for two patients who were allergic to purified lanolin. Consider doing a patch test if you have a history of any of the following:

  • Eczema
  • Sensitive skin
  • Reactions to wool
  • Possible previous reactions to lanolin

C) Wound care products

1) Hydro gel dressings

Hydrogel dressings are a type of wound care product. They consist of water in a gel base. They can come in various forms including shapeless gel, sheets, or contained in fabric. These are medical supplies that keep damaged areas moist and are designed specifically to treat skin damage on any part of the body. Hydrogels do not prevent or treat infection and are significantly more expensive than purified lanolin. They often need a cover to keep them in place and to preserve moisture. 

Hydrogel dressings:

  • Can be gently applied.
  • Prevent scabs and crusts.
  • Can be soothing.
  • Promote healing.
  • Are not toxic for the baby.
  • Are easily removed without sticking.
  • Are unlikely to cause allergic reactions.

There are a variety of hydrogel brands and types. Mothers should avoid adhesive products. Hydrogel dressings are not the same as hydrocolloid dressings.

Our experience is with medical grade hydrogel sheets that mothers cut into 2 cm (1 inch) squares. 

When used in other skin wounds, hydrogel dressings tend to be changed every 1 to 7 days. The timing of this varies between manufacturers and the nature of the wound. 

One study (Brent 1998) compared hydrogel dressings to breast shells and purified lanolin. The patients using the hydrogel dressing had higher rates of infection and pain and healed more slowly. Given the already high risk of infection seen in nipple wounds and the possible increased risk from hydrogel use, it would seem logical that dressings would be changed frequently. We recommend dressings are changed every day. 

We do not use hydrogel dressing if there are signs of infection such as:

  • Discharge.
  • Increasing pain.
  • Increasing redness around the damage.

Some mothers keep the hydrogel products in the refrigerator as chilled hydrogels may help decrease nipple pain. 

Some mothers use hydrogels for nipple pain and without damage. This use should be short-term.

Please follow the manufacturer's directions for their use.

2) Polymem pads

Polymem pads are a more absorbant wound care product. It is marketed specifically for breastfeeding mothers under the Nursicare brand®. They consist of pads that are placed directly on the nipple and can are reused until soaked through. They are more expensive than hydrogel dressings.

 

D) Antibiotic and antibacterial products

Nipple damage often becomes infected. The risk of infection is highest during the first week after delivery and is more likely to be present with deeper damage.

Mothers at higher risk of infection or those that have signs of an early or mild infection may consider antibiotic or antibacterial products. Oral antibiotics (those taken by mouth) are more powerful than products that are put on the skin and may be required for more severe infections.

1) Antibiotic ointment

If you are at high risk of a bacterial infection from your nipple damage or have early signs of one, you and your health-care provider may consider short-term use of a prescription ointment containing an antibiotic to kill dangerous bacteria. Mupirocin and fusidic acid are effective for common skin infections and are reasonable options (CADTH 2017; Stevens 2014).

Antibiotic ointments often contain petrolatum, or petroleum jelly. As an alternative, a pharmacist can combine mupirocin powder and purified lanolin. Antibiotic creams should be avoided as they may delay healing.

To prevent the baby from swallowing any ointment:

  • Use minimal amounts.
  • Only apply it to the damaged area.
  • Before the baby breastfeeds, gently clean the area with breast milk and a soft, clean cloth.

Breast milk will not harm the damaged area and contains a little fat to help clean greasy ointments.

Antibiotic ointments are applied to the skin with a cotton swab or a clean finger. 

2) Medical grade honey

Medical grade honey, which has been treated to remove the bacteria that cause botulism, can be used to prevent and treat infection by slowing the growth of bacteria. It also encourages healing by stimulating the growth of granulation tissue (Norman 2017).

Medihoney® is one brand of medical grade honey and can be applied by pad or as a thick liquid. The former is more expensive. 

Liquid medical grade honey can sting when applied. To minimize this, you can use it occasionally and use purified lanolin the rest of the time. It can also crystallized and the sharp crystals may cause pain. To melt the crystals, wash your hands thoroughly and rub a small amount of the honey between your index (pointer) finger and thumb until the crystals have dissolved.

Medical grade honey does not need to be washed off.

3) Combination ointments

We have found combinations of steroids, antibiotics, and antifungal agents (combination ointments; all-purpose nipple ointment [APNO]) helpful for small, infected, late-onset wounds that do not respond to moist-wound healing combined with antibiotic or antibacterial preparations. This has allowed us to avoid the use of stronger antibiotics by mouth. However, there are concerns with using these.

References

Brent N, Rudy SJ, Redd B, et al. Sore nipples in breast-feeding women: a clinical trial of wound dressings vs conventional care. Arch Pediatr Adolesc Med. 1998 Nov;152(11):1077-82

Canadian Agency for Drugs and Technologies in Health (CADTH). Topical antibiotics for impetigo: a review of the clinical effectiveness and guidelines. Ottawa: CADTH; 2017 Feb. (CADTH rapid response report: summary with critical appraisal)

Dennis CL, Jackson K, Watson J. Interventions for treating painful nipples among breastfeeding women. Cochrane Database Syst Rev. 2014 Dec 15;(12):CD007366

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

Norman G, Christie J, Liu Z, et al. Antiseptics for burns. Cochrane Database Syst Rev. 2017 Jul 12;7:CD011821
 
Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014 Jul 15;59(2):e10-52