Nearly 80-90% of breastfeeding women have been estimated to experience some degree of nipple soreness on account of nipple trauma and infection.1 Nipple pain is common during the first 10 days of breastfeeding and at the time when the infant is teething.2 Sore nipples commonly occur due to abrasions from feeding or from tight fitting clothing. These breaks in the skin increase the likelihood of infections of the nipple, as well as mastitis. Psoriasis, eczema and contact dermatitis may also be responsible for sore nipples.2

Mastitis is an inflammation of the breast and can occur anytime during lactation; however, it is most common during the second and third weeks postpartum. There are several risk factors for mastitis, including sore nipples and yeast infection. Nipple fissures can cause pain and facilitate the entry for bacteria, thus resulting in mastitis. Yeast infection can also increase the risk of mastitis by causing nipple fissures or milk stasis.3 Topical therapy is usually helpful in managing these conditions.

Bacterial infections, commonly caused by Staphylococcus aureus and Group A beta-hemolytic Streptococcus, present with sore, cracked, honey crusted and erythematous nipples.2 Candida infection can present with sore nipples with pain that is not relieved by improved attachment. There may be a red or flaky rash on the areola, with itching and depigmentation. In the baby, white spots may be seen inside the cheeks or over the tongue, looking like milk curds. There may also be a red rash over the nappy area called as diaper dermatitis. The baby often has feeding difficulty due to sore mouth.4 Topical therapy is again useful for this condition.

Nipple pain or infection during breastfeeding often results in cessation of exclusive breastfeeding.3,5 The baby may also have symptoms on account of nipple infection in the mother and feed for a short time and then pull away, or refuse to feed altogether.4

Routine nipple hygiene is therefore very important in preventing and managing such infections. The woman can exfoliate the affected area with a wash cloth after showers and should keep the nipple dry.2 Improper latching to the breast is associated with sore as well as traumatized nipples.6 Using soap and alcohol to clean the nipples dries out the nipples and increases the chances of nipple trauma and pain.7

Virgin coconut oil and kokum butter have been shown to be highly effective in healing dry, cracked and sore nipples and fight infections caused by bacteria, fungi and viruses.6,8

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. 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.
3. Spencer JP. Management of Mastitis in Breastfeeding Women. Am Fam Physician. 2008 Sep 15;78(6):727-731.
4. Management of breast conditions and other breastfeeding difficulties. Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals. Geneva: World Health Organization; 2009. Available from: https://www.ncbi.nlm.nih.gov/books/NBK148955/
5. Kent JC, Ashton E, Hardwick CM, et al. Nipple Pain in Breastfeeding Mothers: Incidence, Causes and Treatments. Int J Environ Res Public Health 2015;12(10):12247-63.
6. 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.
7. Lactation and Breastfeeding. Newton ER (ed.). In: Obstetrics: Normal and problem pregnancies. Gabbe SG, Niebyl JR, Simpson JL, et al. (ed).
8. In: Dr. K. M. Nadkarnis Indian materia Volume 1.