As healthcare professionals we have used expressed breastmilk on sore nipples to help them heal. We know that the many properties of human milk promote the healing of broken skin. What we may not have known was that we are also practicing the art of "wet wound healing" or "moist wound healing". Unfortunately, at the same time, many lactation protocols call for "air drying" or "blow drying" a sore nipple, seemingly contradictory advice.

When considering management and treatment of sore nipples it is important to ascertain why the nipple is sore, and to note whether the nipple skin is broken. There are 3 main reasons a breastfeeding woman may have a sore nipple: structural concerns with mom, baby or both; abrasion to the nipple; or environmental.

The lactating woman may have a structural problem with the breast that does not allow for deep attachment of the infant mouth onto the breast. This can lead to abrasion on the nipple tip and breakdown of the nipple skin. These maternal structural problems include short shanked nipples or an inverted nipple. The structural problem may be with the infant. The baby may have a short frenulum or a tonic bite, again leading to nipple abrasion. Any type of abrasion to the nipple may cause a skin break.

There could be environmental reasons why a breast is sore. When skin is constantly exposed to moisture there is a tendency for it to cause maceration. Constant wet breast pads on an otherwise healthy breast and nipple have been known to cause skin breakdown. This is the reasoning that directed the treatment suggestion of air dying the nipple. If too much wetness is the cause of the sore nipple and skin breakdown, then keeping the breast dry is appropriate. The condition of over wetness is quite rare, but its treatment is very common. This leads to the incorrect treatment modality for most sore nipples.

Another environmental cause of sore nipples is the presence of thrush or candidiasis. The usual symptoms are pink to red nipples with a burning sensation in the skin. The infant may or may not have white patches in his mouth. This is a situation that usually occurs after the first 10 days of breastfeeding and needs comprehensive evaluation and management. Furthermore, wet wound treatments possibly encourage yeast growth.

Each sore nipple situation should be evaluated as to the cause of nipple soreness, and the treatment based on whether there is a break in the skin. We need to both correct the cause of the sore nipple and treat the wound or soreness. When a woman complains of soreness and there is no skin break, correcting the latch and using Lanolin after each feed have proven effective. This breast should be kept dry, or rather, not over wet and watched for a chapping effect.

Any purified lanolin works to maintain the skin's natural moisture and protect the nipple skin from further abrasion. Lanolin is absorbed into the upper layers of the epidermis and should not be removed before breastfeeding. It also forms the slight barrier and chamber that promotes the antibiotic and bacterial action of expressed milk. For an excellent in-depth discussion on wet wound healing visit www.breastfeeding.org and the article by Allison F. Wren entitled "Moistness: The secret of healing sore and cracked nipples".

Hydrogels are dressings that use a saline-based hydrophilic polymer or a glycerin based gel to create a thick gelatinous patch. They have been used in the wound care management field for approximately 20 years but are just now making there way to the breastfeeding field. Opsite(r) was the first to use this technology. These dressings create a moisture chamber and bacterial barrier at the breast wound. This produces an environment that supports healing. It is important that the hydrogel is a semi-permeable film that allows excess moisture to escape yet keeps humidity at the wound bed.

One popular hydrogel in the breastfeeding market is "Soothies" by Puronyx Corporation. They are 65% glycerin 17-1/2% water and 17-1/2% polymer matrix, all of which are non-toxic to the mother and baby. "MaterniMates" are now called "ComfortGel" hydrogels and are sold by Ameda. They contain no glycerin.