After years of hearing "avoid soap on the nipples", I've been reading more and more that it makes sense that a nipple wound could benefit from some of the same approaches as a wound anywhere on the body.  So I do suggest washing with gentle soap and water 1-2 times per day (it may simply be part of a shower routine) when nipple wounds are present, though I encourage the mother to assess her own comfort during this process and avoid scrubbing.  Occasionally I work with a patient who has seen a dermatologist for a non-healing nipple wound and often she will share that she received the instruction to cleanse the wound with soap and water as well as to keep it covered (no airing out) and avoid creams with steroids (slows healing).

In gathering resources for a presentation on breastfeeding tools, I read mentions of soap and water in several of the studies involving hydrogels - or later reviews of those studies.  There were mentions both of the need for a clean wound before applying the hydrogel and the importance of clean hands.  Clean hands and a clean wound before applying anything on top seems like a good common sense approach in any case.

There are some references to soap and water in this excellent article:  Walker, M. (2013). Are There Any Cures for Sore Nipples? Clinical Lactation, 4(3), 106-115 and Cathy Genna Watson's fabulous book "Selecting and using breastfeeding tools:  Improving care and outcomes." (2009).  In my notes from C GW's book, I have "Washing injured nipples twice daily with mild soap and water can reduce the number of bacteria present and reduce the risk of mastitis.  The surrounding tissue is the most frequent source of microorganisms that infect wounds." (p. 7) as well a mention of good hand hygiene.

As far as the manuka honey - I had a very interesting visit with the Manuka Health rep when visiting New Zealand.  They make a breast pad containing irradiated manuka honey that looks a bit like a hydrogel.  The honey is actually irradiated in Kansas City and then sent back to NZ!  The rep shared some really cool photos with me (weeping eczema on the areola treated with the honey breast pad) as well and references to manuka honey research for non-breast wounds.  I would love to see some research on nipple wounds and manuka honey.  From my casual conversation with the rep, I was under the impression they would be interested in this too.  I came home with a big box of the manuka honey pads but found that many pediatricians are still concerned about honey and babies, even irradiated honey.  So I sent the bulk of my pads to Cathy Genna Watson - perhaps she'd care to comment on how she's found them.  


Ellen

Ellen Rubin, MA, IBCLC, LLLL

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