> I remember some wise person on Lactnet saying last summer that one
> source of mastitis is such damaged nipples through which bacteria enter
> the breast.
There is a clear relationship between nipple damage and mastitis.
Lawrence states that broken skin allows a portal of entry for bacteria. A
study by Evans & Heads (1995) related nipple damage to 39.8% of cases of
mastitis, and to 88% of cases of bilatera mastitis in the first two weeks.
Other studies have also found a positive association. However, "positive
association" is not the same as "cause". Since increased feeding frequency
has been shown to be a major protective factor against mastitis, does
nipple damage cause mastitis because of bacterial entry or less
effective/less frequent feeds?

> This is as opposed to the different type of infection that follows a
> plugged duct. The former always needs antibiotic treatment, whereas the
> latter can sometimes be treated without.
This does not make sense to me. Back pressure from a blocked duct can
cause systemic symptoms because of milk leakage into the circulation, even
without an infection. Blocked ducts, even those with early symptoms of
mastitis, don't need antibiotics if cle ed and managed well. However,
infection from bacteria entering the breast (if it does) would be more
likely to need antibiotics.

> I believe that with this hydrogel dressing and the accompanying healing
> from deep within the nipples first and progressing outward, the
> enclosing of bacteria inside might be prevented.
All open skin wounds heal progressively from the wound bed out. Dry wounds
are just slower and may have the mechanical barrier of a scab in the way.
Moist healing is faster so the risks of bacterial entry are less.
Restoring skin integrity is known as the est barrier to infection.

> The presenter gave detailed diagrams of the method of healing that
> takes place beneath this dressing.  The substance is like a very thick
> water--sort of like the gelatinous inside of an aloe plant.
This is not restricted to a hydrogel dressing, it is the same for any type
of moist wound healing with an appropriate medium to prevent air drying.
It is air drying, particularly accelerated drying (eg hair dryers) that
stuffs up healing. This has been known for decades.

Ros Escott BAppSc IBCLC
Tasmania, Australia
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