Naomi, you wrote:

<Since adolescence she has had scabs that appear on her
nipples. They are painless, except when they fall off,
when it hurts. They come and go. She has asked doctors about
it repeatedly over the last 10 years or so, they all
say not to worry, but they haven't identified what it is.
Now that she is expecting a baby, she is concerned that the
baby might swallow the scabs and worries they might
harm the baby.

Has anyone heard of anything like this before?>

What your client is describing as scabs might well be a build-up of
keratin cells that have not sluffed off regularly as is the normal
process for the outer layer of cells on our skin.

When several other LNetters have asked such a question in the past, I
posted about a client (redhead) with that situation, who very gradually
overcame the condition by:
   *making sure the daily bath "soaked" the nipple skin somewhat
    *very gentle friction of the towel in drying, (no more vigorous than
drying one's back or legs)
    *immediate application of a moisture barrier, such as lansinoh or
purelan, immediately after the bath, and perhaps once or twice more
daily.

Serial close-up photos were taken to demonstrate progress. She brought
this to my attention at 28 weeks. I was concerned about the reaction of
the nursery to the appearance and "safety" of her nipples for the baby,
as well as the possibility of tenderness and damage to the underlying
skin if it were to be dislodged all at once, post partum.

We helped her clear it up by 35 weeks. She went on to have a comfortable,
successful nursing experience.

Over the period of 6-8 weeks, tiny bit by tiny bit, the keratin sluffed
off both at bathtime and on her bras and nighties. Out of curiosity, we
had her transfer some flakes to microscope slides and sent them to the
lab, and the pathologist identified it as keratin.

My first clue in all this was that one of my own daughters has mild
congenital ichthyosis, and since the age of 2, has needed "soaky baths"
and moisture barrier application to various areas of her body to prevent
"alligator skin" which would slowly, but eventually sluff off as large
flakes of dead skin if this routine was not followed.

Your suggestion of referring her to a dermatologist can certainly be a
reserve plan if several weeks of the above plan doesn't bring noticeable
improvement.

Jean
**********
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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