Betty writes:
<Permission to post from mom. Baby in the NICU for 2 months uable to breast
feed. Mom pumping obtaining 4-6 ounces every 3 hours. Mom has a coating of
semi-crusty white nipples bilaterally, she states when it comes off it
appears to be powdery. Mom reports no pain, no burning, no itching, no
typical signs of candida, mom says not really a problem, but very strange
looking. The whole nipple tip is affected, mom states it is increasing in
size slowly. Also, no history of exema, mom does not put any type of lotion
or ointment on, but on occasion some olive oil.
Any suggestions would be greatly appreciated.>
Is the mom per chance red-headed? Or have congenitally dry skin? I have a red-headed adult daughter who has what seems to be congenital ichthyosis which has necessitated her using loofas and lotions since a small child. Nothing unusual about nipples though no pregnancy to this point. From observing her, I had a few clues when I was once assessing the nipples of a red-headed mom prenatally, when I saw her nipples with a white 'crust' over the entire tip at 28 weeks g.a. She said they had been that way for months. Only time I have ever seen "tough" nipples! I followed her serially with close-up photos.
The bottom line is that after having her use gentle toweling of the nipple surface after each bath and applying triple lanolin to lock in moisture (the only thing available then), bit by bit parts of the crust began to come off comfortably so that by the time she was ready to deliver, the nipples had no trace (and the hospital personnel did not freak out as I'm sure they would have, back then.)
I had had her capture some of what sluffed off, (and I probably still have the microscope slides and the path report to this day;-) The report was "keratin cells" and evidence of some kind of yeast that was not candida.
I am suggesting that the white powdery semi-crusty stuff is simply un-sluffed off keratin cells that in most people desquamate naturally at bath time, or on clothing, or in babies mouths while nursing. Since the baby has not yet been to breast, that last factor isn't present, despite the moisture exposure of milk during pumping.
Olive oil doesn't sound like a bad idea, especially applying it right after bath time, after very, very gentle friction of "soaked nipples" with a wash cloth, etc. whatever she can easily and comfortably tolerate. Maybe even occasional saline soaks on nipples, gentle friction, and oil, or lansinoh or something to lock in moisture between baths/pumpings???
I predict it wouldn't take very long, and would probably elicit less of a reaction about possible harm to the baby from the LC/nurse who observes the first at-breast session!
FWIW, I think this might be worth sharing with her to see if the idea appeals to her. Please try to take close-up pictures, and perhaps capture some of the desquamated material between microscope slides and get a pathology report. Maybe between the 2 of us, we could write up the case studies together, to help others who see this phenomenon??
Jean
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