The Evil Nip-Nasties: what to do with cracks and blisters

This post was most recently updated on August 17th, 2017

When I was a little girl I was always grazing my knees climbing trees and falling off my bike. I used to love picking at the scabs, worrying away at the edges to see if it was ready to come off. I loved seeing the brand new pink skin underneath. My mum told me scabs were ‘nature’s plaster’ and to leave them alone to let the new skin grow.

And they mostly did the trick, except for the ones right on a bendy joint. Then every time I bent the offending elbow or knee, the scab would crack and I’d bleed onto my saggy, white knee-high school socks.

Fast forward a few years and I didn’t enjoy the scabs on my nipples caused by my slightly prem, sleepy newborn’s shallow latch. No siree, I did not. Wandering around the house with my knockers out drying them out between feeds just didn’t seem to work because every time he fed, those scabs I’d been conscientiously cultivating came right off and I was back to square one. Ouch!

Of course, I needed some help to get him latched on more deeply. Once I had that, things looked a lot more rosie around Chez McMahon. But I could have helped my body deal with those nasty wounds in a bit more of a sensible and effective manner.

Rather than drying out the wounds, I should have kept them moist.

Let me explain…

When we dry out a wound and a scab forms, the skin begins to grow again right under the scab, healing the wound from the top down. If you knock off the scab too soon before all the layers of skin have formed, the wound will re-open. A new scab will have to try to form to start the whole process from scratch again. Each time the wound is reopened, there is a risk of infection.

Clearly, if we want to use those nipples every couple of hours at least and put them somewhere wet, trying to keep them dry is just not going to work.

So we take inspiration from the amazing doctors who began getting great results treating burns and other types of wounds in the 1970s by keeping them moist. The logic is simple; instead of healing from the top down under a scab, when we prevent the body making a scab, the wound heals from the bottom up.

So how do we achieve this magic? With the tiniest little smear of something gloopy. It doesn’t really matter what, as long as it’s not going to give you an allergic reaction, it’s not too nasty for a baby to ingest and it’s thick and gloopy enough to stay on the wound, sealing it and keeping it moist.

The analogy I usually use is our lips: when we get a crack in the cold winter months, if we let it dry out, it will crack open again every time we smile or talk. Keep it moist with a lipsalve and it’s healed by the morrow.

Lanolin or vaseline are what women usually use. Vaseline is by far the cheapest, but some people don’t like the idea of using a petrochemical. Lanolin is purified from sheeps wool. The market leading brand annoys some breastfeeding supporters because the outfit that makes it is not a ‘Code Compliant’ company. It also sells it’s product in enormous tubes, tending to make mothers believe they will need heaps of the stuff, that sore nips are a normal part of breastfeeding and that the product, if used in enormous quantities will ward off the evil nip-nasties.

Lots of people swear by coconut oil. I love the stuff, on my body and in my food, but it melts at body temperature so doesn’t remain gloopy enough to achieve moist wound healing on nipples.

Myths to debunk:

No, these creams are not medicinal in any way – they don’t include any ingredients that ‘soothe’ or ‘speed healing’, they are just hastening healing by the moist wound healing route. Moist wound healing has been clinically proven to hasten healing and is much more appropriate for a nipple anyway, which is going to be stretched and wettened frequently.

No, you don’t need gloopy stuff in massive amounts, smeared from rib cage to sternum. It doesn’t need to be used prophylactically – ie in a preventative or ‘just-in-case’ way (see above). In fact over-use can cause the very problem it’s trying to treat as the baby slips down the slippery boob, latching on shallowly and clamping down on the nipple.

Just the smallest smear, just over the wound itself, will do. Reappling every time it dries, and after every feed or pumping session will do.

For really serious wounds, dressing impregnated with gloopy stuff may help so that the wound isn’t re-traumatised every time you peel off a breast pad. Something like Jelonet is the usual go-to. Some mums use breast shells to keep their clothes from touching very sore nipples.

So if anyone tells you to air-dry your nips or even use a hairdryer on them, their understanding of wound healing and breastfeeding is pre-1970s and they need some serious updating.

For those of you who like to read in a little more detail, here are some quotes and links to ressearch.

The principle of moist wound healing challenges the normal physiological process ofwound repair; ‘dry healing‘ seen by the formation of a scab. It is recognised that inmoist occlusive / semi-occlusive environments, epithelialisation occurs at twice the rate when compared to a dry one¹. http://www.clinimed.co.uk/Wound-Care/Education/Wound-Essentials/Theory-of-Moist-Wound-Healing.aspx

Clinical proof

A study published in the Annals of Plastic Surgery aimed to determine the effects of moist wound care. Researchers used a porcine wound model, to compare wet conditions using saline, moist conditions using hydrocolloid dressings and dry conditions using sterile gauze. The scientists found an increase in the presence of liquids led to faster healing (wet wounds healed after six days, while moist ones took seven days and dry wounds took eight). Additionally, moist and wet wound care led to less necrosis and inflammation as well as higher quality in the newly regenerated epidermis.

Other benefits

In addition to speeding up the progression of wound healing stages, moisture reduces discomfort and pain among patients – pulling off a dry dressing can be terribly unpleasant and even tear away epidermis that has grown during healing. Additionally, moist wound dressings reduce the risk of infection compared to an uncovered wound. This may seem counter-intuitive as many know that wet environments can breed bacteria, but studies have proven that dry healing methods are no more effective at reducing the risk of infection. http://www.advancedtissue.com/debunking-wound-cares-biggest-myth/

Remember, there is always a reason for sore nipples. Get some help from a qualified Breastfeeding Counsellor or Lactation Consultant. It could be just a tiny bit of help getting a deeper latch might mean the difference between pain and pleasure. There are many other reasons for sore nipples, too, so slathering on the gloop without getting to the bottom of the problem may lead you nowhere.

Happy Breastfeeding!