I had an in-hospital, newly delivered mom (full term baby) with a
similar presentation but maybe not the same thing.  She had extremely
dry nipples and areolas, the nipples had numerous small "chunks" of dry
tissue fall off with a moist, smooth disposable washcloth rubbing
lightly over it.  She was a very dark skinned black women and after
wiping the breast with the cloth mentioned above it appeared as soiled
as it would washing a moderately dirty childs face after playing in a
duststorm , just to illustrate how much "skin" or whatever was falling
off.  Go back and do it again and you would get the same results.   I
felt it was dry skin caked with weeks to months of leaking colostrum.
I didn't feel it was poor hygiene but rather normal showering/bathing
but no prenatal lubrication of the dry/dry skin.

I treated her with warm water compresses consisting of 4X4 gauzes
placed over a thick layer of l_n___oh with a warm wet disposable diaper
over it all to hold the heat and maintain the moisture without a lot of
dripping.  We used this about 1/2 hour prior to every feed and followed
the compress with GENTLE rubbing of the nipple with the smooth
disposable washcloth to remove loosened tissue.  The rubbing and wet
compresses also effectively removed the excessive l_n___oh.  She used
the more standard thin layer of l_n___oh after nursing.  Baby nursed
well from the start, nursing staff felt better dealing with "the
problem".  Mom was treated properly and never made to feel "dirty".
She reacted appreciatively to our interventions.

She cleared up prior to discharge at 3 days, maybe by the 2nd day, I'm
not sure.

It never occured to me to culture the but that might have been a good
idea, I suppose, except my docs might have decided to hold
breastfeeding until culture results were back and negative, meaning
1 to 3 days of delayed breastfeeding depending on their acceptance of
preliminary results or the "real" results.

Mom said nipples were dry most of the pregnancy, no advice had been
offered by her OB, nor did she solicit any.  She assumed it was a
normal part of being pregnant.  Needless to say, she did not see a
dermotoligist.

I thought about having her use normal saline for the compresses but
knew she wouldn't get reliable help to warm it and she had had a
C-section to top it all.

I don't know if it was the "right" thing to do except it did work, in
this case.

Good luck with your client.
Carla D'Anna (just north of Washington, DC)