Lisa asked: 

What would cause nipples to lose their outer protective layer within 1 day of birth? Outside of a poor latch and tongue tie. If a nipple looked brown and crusty during pregnancy, what could that indicate? 

Hi Lisa, 


I have encountered this a few times in my work as a hospital-based IBCLC. It has primarily been with African-American women but occasionally it has been in Caucasian women. Most recently, it was a Caucasian mother with a history of dermatitis. 


What I feel is happening, but which I have not found documented anywhere, is that as the areola darkens in pregnancy, in some women it includes adding an extra layer of pigmented skin that then flakes off once the baby arrives. Most often the mother or I notice it on a pump flange, occasionally on the baby's lips or cheek. It is harmless. 


The mother I noted above with dermatitis had what appeared to be darker pigmented freckles on the nipple. The delivery nurse put the consult in for "scabs" on the nipples but the mother stated they had been there in the later weeks of pregnancy and prior to the baby's first nursing. We discussed what it probably was but also other possibilities that would require consultation with a dermatologist. That is when she revealed that she sees a dermatologist regularly for her other skin problems which have included pre-cancerous moles. When I followed up the next day, the darkened areas were gone - they "came loose and flaked off" per mother - supporting the idea of skin pigmentation. The mother did plan to mention to the dermatologist at her next appointment scheduled in a few months after the birth. 


Hope this helps, 


Cindy Garrison BS IBCLC 

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