Barbara,
<At the tip of the nipple was a cluster of tiny berry-like nodules, about
12-15 of them in total, each less than one mm in diameter, but definitely
raised above the skin surface. They were a darkish-yellow. At first I
thought it was dried colostrum, but they did not wipe away with a wet
cloth.>
Could this be keratin from undesquamated skin?
The color fits. 20+ years ago, I did a prenatal nipple exam on a
fair-skinned mother and discovered this condition with rather thick
grayish yellow "scales" covering just the tips of both nipples.
I documented it with close-up photography, from 28 weeks on till 35
weeks. (She is the only mother I can say I have ever seen who had "tough"
nipples!) She went on to have a good nursing experience.
My concern was the reaction of the hospital staff to "allowing" her to
begin nursing if this condition remained. Not that I thought it would
harm the baby, but I hoped to avoid unnecessary problems when it flaked
off eventually during early feedings.
We advised her to bathe regularly as usual, gently give only the mildest
friction with the towel, and coat the area with Triple-Lanolin after each
bath. (Lansinoh was not yet available.)
We sent home some microscope slides and asked her to capture between two
slides anything that eventually flaked off. It came off painlessly,
little by little at bathtime, and was completely gone by 35 weeks. The
pathologist identified it as "keratin, mixed with an undetermined kind of
yeast" (Not candida.)
Since I had a young daughter with a mild case of congenital keratosis,
(which simply needs extra friction to help desquamation when bathing and
lubrication on her skin after every bath or swim), I had a fair idea of
what the problem might be. If the cosmetic means had not been effective,
there would have been plenty of time to refer to a dermatologist.
Hope this helps.
Jean
***************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA
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