Nipple dermatitis: Symptoms, causes and treatment

People who breastfeed are up against a lot. Weird lumps, blocked milk ducts, mastitis, leaking boobs and babies that struggle with latching. It's all really, really hard.

Nipple dermatitis is another irritating, maddening and difficult to manage aspect of breastfeeding that can occur even in the most experienced breastfeeders out there.

Known also as nipple eczema, it can be so painful, raw and itchy that it's been known to drive people away from breastfeeding.

Here at Kin, we want to do everything we can to support you on your breastfeeding journey, so we've provided a guide on how to identify nipple eczema and how to treat it effectively.

What is nipple dermatitis?

Nipple dermatitis or nipple eczema is one of the many common skin conditions a woman can experience in her life, especially when she first begins breastfeeding.

It is a red, itchy, scaly rash that can appear on your nipples and areola (the dark skin surrounding the nipple).

It is classified as an irritant contact dermatitis, or atopic dermatitis, because it is in reaction to what the nipple has come into contact with.

Eczema is identified as damage to the skin barrier function (the “glue” of your skin) and is chronic.

People who suffer from eczema are usually more sensitive and prone to infection and dryness.

Eczema can be worsened by a number of environmental factors including fabrics, weather, fragrances and a number of other things that we will touch on in this article.

Unfortunately for the eczema sufferers out there who already have sensitive skin, you may be more likely to experience nipple dermatitis.

But! You're probably already armed with information, tips and tricks on how to manage nipple eczema — because managing your nipple eczema symptoms is very similar to managing eczema flare ups on the rest of your body.

Nipple eczema vs. nipple thrush

Be mindful: nipple eczema is the not the same as nipple thrush.

‍Nipple thrush is characterised by pain in one or both nipples after feeding and is actually a fungal infection.

Thrush infections can happen when your nipples become cracked (a normal aspect of breastfeeding) and are exposed to too much moisture.

To avoid nipple thrush, ensure your nipples are dry after you feed and make sure you are changing your breast pads frequently.

Your breast pads also should always be well-washed and completely dry before you pop them back into your maternity bra, so using high-quality, breathable pads like the ones made by Kin Fertility will help prevent the onset of thrush.

Nipple eczema vs. Paget's disease

Paget's disease of the breast, also called mammary Paget disease or Paget's disease of the nipple, is type of rare breast cancer.

It has many of the same symptoms as nipple eczema (e.g. flaky, scaly, red, itchy skin) which can sometimes lead to a misdiagnosis.

If your nipple eczema is not clearing up with a natural nipple cream or topical steroids, see your doctor about a mammogram and blood test.

Is nipple dermatitis dangerous?

Nipple dermatitis is not considered dangerous. However, due to the breakdown of the skin's barrier, skin can become raw, red, itchy and easily broken if scratched or if your baby's sucking breaks the skin.

This can lead to a bacterial infection if not treated.

What's more, there is a direct link between nipple eczema and mastitis.

If you have to interrupt your breastfeeding sessions because your nipples are too sore, you may not be emptying your breasts enough which could lead to blocked ducts and, consequently, mastitis.

This is a lot to take on, but don't panic; once you understand the causes and signs of nipple eczema, you can treat it quite easily and then get back to breastfeeding.

What causes nipple eczema?

Dermatitis around the nipple and areola can be caused by: 

• A prior history of eczema: Nipple dermatitis from breastfeeding often occurs in patients with current or past eczema elsewhere. Eczema can occur due to an allergic reaction (to certain foods, fabrics, fragrances, lotions and other environmental factors), immune system issues and even stress.
• Certain nipple creams: We know — this seems unfair, doesn't it? But, some of the creams, lotions and balms that have been marketed to soothing sore nipples can actually make nipple eczema worse.
• Shampoo and body wash: Some soaps for your hair and body may also trigger nipple dermatitis, especially those that are strong in harsh chemicals, fragrances or are overly synthetic.
• Exposure to heat: Heat, especially in the form of hot showers, can dry out your skin, stopping it from healing and making the skin crack even further.
• Detergents: Certain harsh laundry detergents used to wash your bra, breast pads or undergarments may trigger nipple dermatitis.
• Fabrics: Clothes made from synthetic materials such as polyester, rayon or spandex can trigger nipple dermatitis, especially if they are frequently rubbing against your nipples.

What are the signs and symptoms of nipple dermatitis?

Nipple eczema can be identified by an itchy, scaly, irritated and raw rash that develops in the areola. In severe cases of nipple eczema, your skin may crack or leak a thick, yellow or white discharge.

Essentially, look out for:

• Dry, inflamed redness in the skin around your nipple
• Itchy, painful, burning or sensitive skin
• Nipple discharge
• A rash that has brown, red or gray patches or spots
• Scaly, leathery, dry skin that peels, crusts or scabs over
• Bumps that are swollen or appear to be swelling
• Small bumps that ooze pus

How do you treat nipple dermatitis?

Luckily, nipple eczema is common enough that doctors have figured out the best methods for managing it.

Here is a list of tips for managing and preventing the recurrence of nipple eczema.

• Stop using creams, ointments and balms that trigger nipple eczema. These include petroleum jelly-based lotion and fragrance-heavy creams.
• Use a nipple cream that includes natural oils. Natural oils such as shea butter, purified lanolin, avocado oil and beeswax are highly effective for helping repair the skin's broken barrier.
• Use natural soaps, shampoos and body washes with ingredients that won't irritate the skin.
• Wear clothes made of natural, breathable fibres such as cotton and bamboo. Use breast pads made from natural fabrics too.
• Avoid hot showers. Hot showers lead to dry skin, which can stop the healing process your skin needs. Try warm to lukewarm showers.
• Rinse your nipples with water after feeding and let them air dry. Once dry, you can safely apply a moisturiser or nipple cream. Do not use a hairdryer to dry nipples, as this can further dehydrate skin and lead to more cracking. It's important to air dry only.
• Apply breast milk to affected areas and let air dry. Breast milk not only nourishes your baby, it can promote healing of your sore, cracked, angry nipples! But, it's extremely important you let it air dry on your nipples. Moisture trapped on your skin can make the irritation worse, which is why you must also change your wet breast pads often too.
• Apply topical steroids for severe cases (sparingly). This treatment will need to be prescribed by a doctor, so make a visit to your GP to get your nipples checked out if you think you need more help.
• Take over-the-counter antihistamines to help manage itching. Note: antihistamines will not cure your nipple eczema, so make sure you take them in conjunction with a topical treatment.
• Use nipple shields, at least for a while as you continue breastfeeding. Nipple shields are a flexible silicone cover you can place over your nipple prior to breastfeeding. They do an excellent job of protecting your nipples, allowing them to heal and allowing your baby to continue feeding.
• Ensure your baby has a good latch. This is really hard to determine sometimes, we know. If you keep developing nipple eczema, your baby might not have a good latch. If you're not sure, see your doctor, a child health nurse or a lactation consultant for breastfeeding support.

Nipple eczema can cause extreme discomfort and emotional pain. In severe cases, the itchy rash and dry skin can make it difficult to move, wear clothing and even sleep. And, it can curtail your desire to breastfeed.

This makes sense — who wants to continue something that's causing pain, anyway?

These symptoms can cause already sleep-deprived and exhausted mothers a lot of distress, which is why it's important to have a natural, effective nipple cream in your postpartum toolbox.

Kin's own Nipple Cream uses an Australian-made formula of all-natural ingredients designed to nourish and restore nipples.

Gently apply a pea-size amount to the affected nipple area with clean, dry hands to promote healing.

With avocado oil, lanolin and shea butter, it works to build skin elasticity and prevent chafing and cracking.

It's also completely breastfeeding safe: there's no need to wipe it off before baby latches on.