Way back in 1992 I was asked by the UK's National Childbirth Trust to
comment on a proposed report on "White spots" on nipples. They did publish
an article on this in 1993 I think, in New Generation, their excellent
magazine. To save myself time, I've edited my response.Apologies for a long
post, but I won't send a file!!!
...I agree with what you've said only I believe there are three types, the
third a sub-type of number 2.
1. Milk blister, an epithelial problem so well described by Gunther, whose
treatment is outlined by you, in BF Matters and in Gunther's original book.
Most common in the early days of lactation I suspect, and sometimes
recurrent but readily seen, diagnosed and treated. [For those of you
without access to these resources, diagnosis of milk under the skin always
involves seeing a blister bulge outwards as the breast is compressed and
milk forced down the ducts.] Often heals over and occasionally the broken
blister needs to be trimmed a bit to prevent recurrence: this can be done
most safely by the mother who can feel the instant the scissors approaches
or touches her very sensitive underlying skin layers and is therefore least
likely to do any further damage or introduce infection.{I wouldn't call
Arly's case a milk blister from the description given.]
2. Milk duct obstructions of two kinds:
2a corpora amylaceae (s. corpus amylaceum) casein-calcium
concretions that are dry, discrete, will pop out under pressure: see ALCA
News piece on this. [I'll try to locate and post this: must have been a
1992 issue.]
2b a less discrete, stringier, fattier substance that does not pop
but can be extruded like fine vermicelli from milk ducts: origin
obscure,but this is the one that relates to excess saturated fats in diet
and or dairy allergy in mothers (often undiagnosed).
No 2 (a and b) is related to recurrent obstructive mastitis, once called
"caked breast", and antibiotics are NOT a help except in enhancing
phagocytic clearance, but often lead to thrush.
Perhaps you should talk to dairy physiologists like Malcolm Peaker at the
Hannah in Reading. Cows milk often contains solids of various sorts, as
anyone who's strained the house cow's milk can testify. At least some of
these are endogenous rather than introduced by the proximity of the cow's
udder to the ground! Mastitis leads to an increase in these, I am told. The
process of making milk is a dynamic one, and milk is a living product in
which interactions continue after production (e.g., lipases digesting
fats). What influences these changes I do not know, but type 2b frequently
disappears (after months of recurrences, often pre-menstrually) in
Australian women who reduce saturated fats by going dairy-free. I suspect
some mammary response to bovine milk fats (or the protein in the milk-fat
globule?) is involved. Usually women who lose this sort of recurrent
premenstrual mastitis problem also lose other allergy symptoms such as
migraine, easy bruising, excessive fatigue, mood disturbance, and maybe
more classic ones such as wheeze, eczema, etc.
But don't overlook the obvious re white spot (as I have on occasion!) :
3. Thrush: often no more than tiny white adherent flecks in crevices of the
nipple, but sometimes distinct white patches blocking nipple ducts. Gentian
violet is STILL my preferred treatment for this and I consider it
scandalous that such a useful, effective, low-cost medication with not a
shred of evidence of human carcinogenicity has been restricted on the basis
of MTD testing on mice. (One day there'll be time to investigate that study
and its funding. But there was no vested interest to defend gentian violet
when it is a generic, inexpensive, and its restriction means the increased
use of prescribed expensive patented brands.)
4. Local infection: pus can look white; nipples can get infected;
Montgomery's follicles can become "infected whiteheads", so to speak. Clean
this out and disinfect: if the lesion is not extensive a very very small
dab of tinc. benz does the trick, though the alcohol will always hurt. Of
course it's normal for there to be some sebaceous secretion able to be
extruded from Montgomery's follicles. I've read of some of these follicles
connecting into the ductal system and excreting milk too.
I'll be interested in hearing how this fits everyone's experience.
Maureen M.
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