I just saw a mother of a 6 month old who has what appear to be small nipple blebs in the center of each nipple.  From her description over the phone of nipples that burn all the time and shooting pains, she was treated in the past by other LC's with clotrimazole, then gentian violet, and later a nurse practitioner prescribed nystatin cream, all with no relief.  She saw her doctor a couple of weeks ago with what she described as "white skin coming out of the middle of the nipple," the doctor "scraped it out" and she felt immediate relief.  She'd tried to do the same thing herself subsequently but couldn't get it, and I saw her for the first time a week ago.  There is almost nothing to see, but there do appear to be what might be small blebs with milk underneath.  I suggested at that time that she soften them with olive oil on a cotton ball and then get in the tub, open them up and try to express any thick material that may be clogging the pores, as suggested by Dee Kassing in her post of Nov. 24, 2003.  She was unable to express anything but milk of normal consistency, but then she has not had any plugged ducts, either.  There is no real history of yeast, and baby's mouth is also clear.  I watched baby nurse and saw nothing remarkable; he appeared to latch on appropriately and nurse well. Nipples and surrounding skin look absolutely normal, except when you look closely at the middle of the nipple face.  She describes the pain as terrible when baby first starts nursing and then gets tolerable, and is taking large doses of ibuprofen to cope with the pain.

Any ideas for treatment, if these ARE blebs?  The relief she feels when she opens them up seem consistent, but I am unsure why they keep closing over.  I had suggested she apply Polysporin after opening them up.  She feels slightly better when she applies Lansinoh, but I really have nothing much else to offer her.  I did suggest lecithin, and another LC suggested she cut down on the large quantities of whole milk that she's drinking, but plugs do not really appear to be the issue here.  Any ideas for what I can suggest she try?

Becky Krumwiede, RN, IBCLC
Appleton, Wisconsin

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