This refers to the case I requested suggestions on a few days ago.  Thanks to all who replied, it gave me a lot to think about.
I saw this lady yesterday.  Did a culture from her nipple, observed her feeding baby who has gained 2 lb over bw (4080 g to nearly 4900 g, grown at least 6 cm in length over same period) and got a more complete history.  I think dry healing here won't work (she has tried it too, no relief).  What feels good to her are  limpet shells and expressed milk on the sore area.  Feeding is only moderately uncomfortable, what bothers her the most is that her breast looks unappetizing.  Before the birth, her left nipple had a "smile" at the tip-- an inversion which was folded inward leaving a visible smile on the surface.  There is just no skin at all over the area inside that smile, so that after a feed there is a heart-shaped area of uncovered nipple tissue visible, about half an inch across.  Within seconds, it recedes somewhat so that the skinless tissue doesn't protrude-- her nipple retracts a little-- but never so much that it is invisible.  (Think of how much lips show when you press them together after applying lipstick, compared to how much show when you pucker up.)
It didn't look infected or even especially inflamed, but I did a culture to be on the safe side.  I am advising her to try anhydrous lanolin while we wait for the results in hopes that the theory outlined in the BF answer book on moist wound healing will apply.  I may try to get hold of some of the other topical stuff mentioned by several of you, but they aren't all available in Norway so we need to start with this.  I also tried to reassure her that the baby isn't bothered by the appearance of her breast!
Will keep you posted!
Rachel Myr
Norway
Rachel

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