Mary posted about a client who has had a thick crust over both nipples which
rubs off and exposes tender skin underneath, but does not appear to be
eczema.  I had an indentical situation.  My client also verbalized the fact
that she had deliberately not been doing anything to toughen the nipples --
just using water.  The problem was, she oozed whatever fluid women ooze from
nipples when pregnant.  We call it colostrum after the baby is born, and I
guess (but don't know for a fact) that it is the same or similar in
composition during preg.  But I digress.  The point was, she had heard a
good treatment for sore nipples was to rub breastmilk back into the skin.
Since she was scrupulously NOT using soap on her nipples, she built up over
time, a really thick layer of crusty, dried secretion. I was somewhat
puzzled when I looked at it, but since it looked like stuff my children have
been known to harbor behing their ears at certain ages, I took a soapy warm
washrag and we dabbed at a corner of the crust.  It came right off.  The
skin underneath was pink and a bit tender.  She went home and got in a hot
shower and soaked and soaped.  The underlying skin toughened to normal
within a day or so with exposure to air, light and normal cleansing.

There are doubtless skin conditions which could cause skin to crust and scab
over -- like impetigo.  If she gently removes the crust and it comes right
back, I'd send her to an md -- maybe straight to a dermatologist -- to see
about approp. treatment with meds.

Let us know how this turns out.

Barbara Wilson-Clay, BSE, IBCLC
priv. pract. austin, Tx