I have often observed poor healing in fissured dimpled nipples.  Part of it
is that even when not nursing, this area is constantly under folds of skin
(like the area under a foreskin, or a really "inny" navel) and hygiene can
be problematical.  Secretions can pool and become growth media for fungal
and bacterial overgrowth.  I suggest gently pulling back the skin and
washing under shower.  Also, it may be necessary to treat with anti-fungal
or antibiotic creams.  Tissue which fails to heal in other places on the
body are understood to be infected or continually abraded.  Same phenomenon
happens with nipple skin.

 I recently posted about a client with horribly wounded dimpled nipples.
She'd had them for about a week before I saw them. Our plan of action
included bottle feeding the infant pumped breast milk due to her intense
pain when latch was attempted. I took mother off Mini-Electric and put her
on Lactina.  Asked her to contact MD for Bactroban.  Two days later asked
her to contact MD for oral antibiotics for terrible shooting pain in breast.
Milk supply very depressed.  Told her to keep pumping at q3hr intervals and
not worry about it. Day 6 of plan all pain gone and nipples closing, milk
supply recovering slowly.  More severely damaged (1/3rd of nipple tip
eroded) rt nipple took almost 2 weeks to close.  Milk supply continued
recovering to normal levels. I discouraged any l-o attempts before tissue
closure.  Made 2 visits on successive days to home when nipples closed to
assist her in transitioning baby to breast.  Nipples nicely everting thanks
to pumping.  Good positioning in side lying encouraged baby to take breast
without needing to use shield -- which I thought might be necessary because
of all the bottles.  In between last 2 visits received call that rt nipple
(which still dimples when at rest) is tender.  Discussed mixing up dilute
solution of white vinegar and water in spray bottle and retracting this area
& gently spraying  area several x a day, 1st with vinegar solution and then
rinsing with clear water to continue hygiene appropriate to preventing
fungal overgrowth. I also suggested she use soome gentian violet once or
twice. Reminded to retract tissue to bathe it  while showering.

  Last phone contact 5 days after last visit:  Milk supply appropriate to
baby's intake needs, baby nursing ad lib and growing great.  Nipples both
healthy. Whole affair took approx 3.5 weeks during which mother needed lots
of reassurance that some fixes aren't quick, but that all would be well in
good time.  This is mother's 3rd and prob. last child -- first ever
successfully bfed.  Home birth with no meds or interventions and nice,
skillful midwives.
Barbara


Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html