Jeanne,

< After all, whether we see it or not, we lose
layers of skin to babies while breastfeeding - some is just more visible
than others.>

I agree with your post. This is often seen on the flange/bell  of the
breastpump, more noticeable with mothers with darker areolar
pigmentation.

I recently saw a caucasion mom with light brown areolas one of which had
a large, darker, leathery circular area on one side which had developed
during pregnancy. Flakes could sometimes be seen on the baby's lips. The
nipples were not involved and the slight damage to her nipple skin in
early nursing was no more than commonly seen when mom and babe are
struggling to learn to latch well. Increased melanocyte activity in the
areolas and the linea negra and mask of pregnancy, etc. might be the
reason for the darker color of the area. I have no idea why it was just
in one circular area. It was gone by 2 weeks of nursing.

One of my children, a redhead with pale skin, has congenital ichthyosis,
I think it is called. By 2-3 y.o., in winter when heat and dry air were
present, on certain areas of her body. the keratin (the outer dead layer
of skin cells), would fail to desquamate regularly  through bathing and
toweling, and we started Keri lotion as necessary after baths and
vigorous toweling. Now that she is an adult, loofas, buff puffs, bath
gloves are the order of the day, and she tries out the latest cosmetic
moisturizers like others try out lipstick and cologne!
(She has glorious hair genes to compensate!)

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 slides at all stages of the
discovery and resolution of the condition.

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.

Are there any dermatologists lurking? What say you?

K. Jean Cotterman RNC, IBCLC
Dayton, OH

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