Pam,
I remember describing a case that sounds just like this. I searched my
"personal archives" of posts I have sent, and found it from 3/5/99. ( It
was in fact, sent in reply to your Lactnet post of 3/3/99 about "Leathery
areolas"!)
I began with a description of the skin care of one of my daughters, a
redhead, who has mild congenital ichthyosis, and then explained that
familiarity with her problems of getting her keratin to desquamate helped
me when I once saw a mother with nipples as you describe:
<Years ago, when I once saw a mom with similar coloring and skin history
for prenatal care, I had some familiarity with the condition. When I did
a nipple assessment in the 3rd trimester, I was amazed to find, just on
the end of the nipple, a 0.5 cm round buildup of many layers of thick
keratin. Nipples were pale pink, but keratin had a yellow-gray tinge.
(They were the only pair of "tough" nipples I have ever seen!)
I could just imagine my reaction if I were a hospital nurse putting the
baby to breast. Enough to freak one out over what to do at that stage of
the game! So prenatally, I had her bathe as usual and put triple lanolin
on the nipples after baths (the only lanolin preparation pleasant and
easy to put on at that time). After two weeks of this, it was only
slightly better, so I gave her some lab slides and had her use a q-tip to
remove some cells after a bath, and we sent them to a pathologist.
His report was essentially keratin, with some kind of yeast (he specified
it was not candida), which if I remember his report did not make a big
deal of. I reassured her it was just an extension of her past skin
characteristics and probably of no consequence to the baby, but would be
sure to create a wave of questions at the hospital if it was still so
thick at delivery.
I had her continue the routine with the addition of an extra little
gentle friction with the towel over the areas, being sure not to be too
vigorous or cause discomfort. By 36 weeks gestational age when she left
our system to transfer to the hospital clinic, it was completely cleared,
without any discomfort, and when I called her to follow up, she had a
very satisfactory nursing experience.
I took photographic slides at all stages of the discovery and resolution
of the condition. Somewhere, I still have the glass pathology slides and
the pathologist's interpretation of them, in my "stashes of unusual stuff
really too interesting to throw away."
It may be that the old custom of having mom's "toughen" their nipples
with towel friction years ago may have kept some keratin from
accumulating heavily. But other than the esthetic effect, I don't think
there is anything detrimental.>
I predict it will resolve with the baby ingesting a little extra protein
as the keratin comes off, tiny bit by tiny bit while nursing. I think you
are doing exactly the right thing by telling mom (and everyone else)
DON'T PICK AT IT ANY MORE! If anything, the "toughened nipple skin" may
work in the mom's favor if engorgement brings about a less-than-perfect
latch.
Out of curiosity, was this mother by chance a redhead?
Jean
______________________________
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio
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