About 80-90% of breastfeeding women are estimated to experience some degree of nipple soreness owing to nipple trauma and infection.1 In an evaluation of the prevalence and factors associated with the occurrence of cracked nipples in the first month postpartum, the prevalence of cracked nipples was 32 % in the first 30 days postpartum. The factors significantly associated with the occurrence of cracked nipples included poor breastfeeding technique; breast engorgement; cesarean section; use of a feeding bottle; and higher maternal education level.2 Suresh et al3 assessed breastfeeding problems in the 1st postnatal week, their predictors and impact on exclusive breastfeeding rate at 6 months. About 89% of the mother-newborn dyads had one or more breastfeeding problems before discharge. Positioning and attaching the infant to the breast was a major issue (88.5%), followed by breast and nipple problems (30.3%). During follow-up, the most common breastfeeding problems included poor positioning and attachment (70.3%), sore or cracked nipple (17.8%), retracted or flat nipple (15%), and breast engorgement (13%).

Improper latching to the breast is associated with sore as well as macerated/traumatized nipples.4 The use of soap and alcohol to clean the nipples tends to dry out the nipples and increase the chances of nipple trauma and pain.5 Trauma to nipples, in turn, increases the chances of nipple infection.6

In order to manage dry, cracked and sore nipples, several treatment options are available including correct positioning and latch, washing the nipple with water, topic mupirocin, topical steroids for inflammation, antibiotics or antifungals depending on identified infection, etc.4

However, the choice of topical preparation for dry and cracked nipples should be guided by its impact on the nipple skin and the baby. Products containing petrolatum should be avoided since they can interfere with skin respiration and can prolong nipple soreness. Alcohol containing products have a further drying effect on the already dry and cracked nipples. It should therefore be avoided.7 As mentioned earlier, soap also dries out the nipples.5 The use of breast milk itself is a potential lubricant that can help soothe cracked, sore nipples.7,8

Virgin coconut oil and kokum butter are effective choices to heal dry, cracked and sore nipples. Virgin coconut oil has long been in use in tropical countries, as well as in Ayurvedic medicine for skin disorders. Positive results have been reported by lactation consultants with the use of virgin coconut oil on sore nipples. Virgin coconut oil has a broad spectrum of activity against S. aureus, fungi, and viruses.4 Virgin coconut oil has been noted to heal the wounds much faster than untreated wounds, possibly on account of the range of biologically active ingredients found in coconut oil. These ingredients speed up the wound healing process. Virgin coconut oil has also been found to be better than olive oil in its ability to eliminate S. aureus from adult skin with atopic dermatitis.4

Kokum oil, or kokum butter, is useful in certain skin conditions. It has been used successfully as an application for ulcerations, fissures of lips, hands, chapped skin, as well as wounds and sores associated with inflammation.9

A topical preparation with virgin coconut oil and kokum butter may therefore serve as a potential agent for healing sore, cracked nipples.

References

1. Saeidi R, Robatsangi MG, Tafazol M. Effect of aloe vera gel on nipple sores. Iranian Journal of Neonatology 2010;1(1):13-4.
2. da Silva Santos KJ, Santana GS, de Oliveira Vieira T, et al. Prevalence and factors associated with cracked nipples in the first month postpartum. BMC Pregnancy Childbirth. 2016; 16: 209.
3. Suresh S, Sharma KK, Saksena M, Thukral A, et al. Predictors of breastfeeding problems in the first postnatal week and its effect on exclusive breastfeeding rate at six months: experience in a tertiary care centre in Northern India. Indian J Public Health 2014;58:270-3.
4. Walker M. Are There Any Cures for Sore Nipples? Clinical Lactation 2013;4(3), http://dx.doi.org/10.1891/2158-0782.4.3.106.
5. Lactation and Breastfeeding. Newton ER (ed.). In: Obstetrics: Normal and problem pregnancies. Gabbe SG, Niebyl JR, Simpson JL, et al. (ed).
6. Khan T. Common Breastfeeding Problems, Part 3 of 3: Nipple Pain + Infection. Available from: http://www.familydocs.org/f/14.CME_.Spotlight.JAN_.Breastfeeding.pdf. Accessed on March 21, 2018.
7. Breastfeeding techniques and devices. In: Counseling the Nursing Mother: A Lactation Consultants Guide. Lauwers J, Shinskie D (eds.).
8. Mohammadzadeh A, Farhat A, Esmaeily H. The effect of breast milk and lanolin on sore nipples. Saudi Med J. 2005 Aug;26(8):1231-4.
9. In: Dr. K. M. Nadkarnis Indian materia Volume 1.