Hello everyone,

I was wondering whether someone can help me out with a problem. I had a mum
to be in a class a few weeks back and she has now approached me again
because she is concerned about her nipples. I have had a look at them and
made some photographs but am ceratinly not sure what it is. Although it
looks to me like a build-up of keratin/skin cells and not psoriasis or other
skin problems. On the tip of the nipples there hard small (about1-1.5mm)
crusts which are a dull shiny brown-grey colour. I know this is going to
ring some bells by some people (Jean Cotterman?) because I remember it being
discussed on lactnet over the last years. Infact I have searched the
archives and found the posts by Jean and others, and I must say that 'my'
mothers nipple problem really sounds the same.
I say problem, we don't know if it is really a problem yet. This mother has
had this type of nipple crusts since the begining of peuberty and it has
never been irritating in the sense of itching, pain etc. Now and again one
of the crusts will fall off after having a shower if she is too rough with a
towel, there is no bleeding after and the skin underneath appears normal.
She has further no other skin problems or other health issues and in my
opinion is really healthy (I've known her a few years now, she's 24 years
old primi). The real concern is what will happen with the breastfeeding -
well motivated to breastfeed!
I think that I will suggest that she visist a dermatologist so that he can
exclude any skin disease that might need treatment and hopefully give her
some peace of mind. The bf people I've spoken to think it must be psoriasis,
but I don't tend to believe them. I do believe my first gut feeling that it
is somekind of active skin cells producing keratin that builds up and
occasionally sloughs off. The nipples also seems to be quite deeply
crevassed (rather than round pits), I presume the milk pores sit in the
crevasses and that the keratin layers are not blocking the pores? Would it
be an idea to remove the hardened crusts in preparation for breastfeeding
(warm soaks & lanolin?) or just wait and see what happens? At the moment my
advice is wait and see, if crusts slough off, then maybe purelan if
required.

Thus, I'd be interested in any new insights into this, I can't find any
thing in my texts. I have photo's that she has given me permission to mail
if anyone has any experience in dealing with these sorts of nipples.

yours hopefully

Sara Bernard
The Netherlands
(amazed at my ability to remember discussions years back on lactnet!! ;-)

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