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Am Fam Physician. 1999;59(5):1264-1267

Nipple soreness is common in women who are breast-feeding and may cause mothers to prematurely wean their infants. Potential complications include secondary nipple infection resulting from skin breakdown. Factors such as recurrent suction trauma to the nipple, oral flora from the infant and a constant fluctuation between wet and dry environments make effective healing difficult. A new treatment approach uses a glycerin-based occlusive dressing that is absorbent and nonadhesive, with bacteriostatic and fungistatic properties. Brent and associates conducted a randomized controlled study to determine the safety and effectiveness of occlusive wound dressings compared with conventional treatment for sore nipples.

Women who presented to a lactation center with cracked, crusting or bleeding nipples, or with pain associated with breast-feeding, were eligible for this study. Those who had an active breast infection or another pain-related condition were excluded from the study. Women were randomly assigned to receive either conventional treatment or treatment with the occlusive dressing. All women received a complete physical examination and specific training in proper breast-feeding techniques and management. Women in the conventional treatment group were instructed to massage their breast milk onto their nipples after feeding, allow the nipples to air-dry and then apply lanolin cream and breast shells. Women in the experimental treatment group followed the same steps but applied occlusive dressing rather than breast shells. A new dressing was applied after each feeding. Patients were seen three times over the next 10 days or until their symptoms resolved, whichever occurred first. The principal outcomes measured included changes in the physical appearance of the nipple and the breast-feeding techniques of the mothers, and changes in patient reports of breast pain.

Forty-two women were included in the study (21 women in each treatment group). Demographic data were similar in both groups. Three women were unavailable for follow-up (one from the conventional treatment group and two from the dressing group), nine women withdrew because of breast infection (two from the conventional group and seven from the dressing group) and one woman from the dressing group withdrew because of dermatitis, leaving 18 women in the conventional treatment group and 11 women in the dressing group.

The appearance of the nipples improved with treatment in both groups. However, women in the conventional treatment group showed a much higher degree of healing at follow-up visits. This difference was statistically significant. There were significantly more infections in the occlusive-dressing group, which resulted in early discontinuation of the study. There were no significant differences between groups in pain behaviors during breast-feeding. Both groups reported less pain during breast-feeding at follow-up, but women in the conventional treatment group reported greater reductions in feeding-related pain. Treatment satisfaction was generally high in both groups of women.

The authors conclude that conventional treatment for nipple soreness, consisting of the application of breast milk, lanolin cream and breast shells, is more effective than the use of occlusive dressings. Conventional treatment for the prevention of sore nipples when combined with instruction on proper breast-feeding technique should remain the treatment of choice for most women.

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Copyright © 1999 by the American Academy of Family Physicians.

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