The Lactnet archives should contain lots of information about eczema of the
nipples.  There were two articles in Journal of Human Lactation in 1993, Vol
9(3).  One, by Kathleen Huggins and Sharon Billon documented "Twenty Cases
of Persistent Sore Nipples:  Collaboration Between Lactation Consultant and
Dermatologist" and one, by Lisa Amir (an Australian MD) discussed "Eczema of
the Nipple and Breast".  Lisa Amir graciously granted Kay Hoover and me
permission to use a picture of a woman with eczema of the nipple and areola
that is included in our book, The Breastfeeding Atlas, which contains a
section on managing women with skin conditions of the nipple. Other main bfg
texts all reference dermatological issues that affect breastfeeding.

In general, the wet-dry-wet-dry stress of bfg can increase the risk that
atopic women will experience tissue breakdown in the nipple/areola area.  A
question I always ask women with irritated nipples is:  Do you have any
outbreaks of rough or irritated skin elsewhere on your body/Do you have a
history of dermatitis?  The challenge becomes keeping that skin healthy by
reducing exposure to hot water, chlorine, and by making sure baby is well
latched.  There may be an association with food allergies that create
changes in the saliva of the baby, or associations with creams or topicals
mom may be applying to the nipple.  I've seen women treat very aggressively
for "thrush" when what they really had was atopic dermatitis, and the
resulting irritation from weeks of tx with gentian violet or topical
antifungals really worsened their sx.  Dermatologists can often prescribe
creams (typically steroids) that when used appropriately can reduce the
inflammation to tolerable levels, and then can be applied on an as-needed
basis if things flare.  Enhancing the maternal diet with essential fatty
acids is another approach, although this is not a quick fix.

Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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