Accurate assessment of the wound will facilitate the development of an effective treatment program that allows optimal wound healing to occur. A four-stage system for rating nipple trauma has been developed to standardize the reporting and management of nipple trauma.
STAGE 1 - SUPERFICIAL INTACT
Pain or irritation with no skin breakdown (superficial trauma, no broken/cracked skin). May include redness, bruising, red spots and swelling.
Recommended Treatment: Expressed Breast Milk (EBM) is often recommended for Stage 1 nipple trauma as it is readily free and available and has antibacterial properties. EBM is not an appropriate solution if there is broken/cracked skin as it dries quickly, does not provide moist wound healing and is sticky when dry which may cause adherence of the nipples to clothing resulting in more trauma to nipples. Purified Lanolin is also recommended to promote moist wound healing for Stage 1 (superficial trauma, no broken skin) and Stage 2 (superficial with some tissue breakdown) nipple trauma.
Click here for more information of Healing Sore and Cracked Nipples.
STAGE 2 - SUPERFICIAL WITH TISSUE BREAKDOWN
Includes pain with possible abrasion, cracks or fissures and shallow ulceration.
Recommended Treatment: Purified Lanolin is often recommended to promote moist wound healing for Stage 1 (superficial trauma, no broken skin) and Stage 2 (superficial with some tissue breakdown) nipple trauma.
STAGE 3 - PARTIAL THICKNESS EROSION
Skin breakdown with destruction of the epidermis to lower layers of the dermis. May include deep fissures, blisters, and deep ulcerations.
Recommended Treatment: For more severe nipple damage such as Stage 3 and 4 nipple trauma, hydrogel dressings are the most effective option as these dressing absorb wound discharge and prevent the broken skin from adhering to clothing. Water-based hydrogel dressings offer lower rates of breast infections and superior pain management for healing severely damaged nipples.
Click here for more information on Healing Sore and Cracked Nipples.
STAGE 4 - FULL THICKNESS EROSION
Deeper damage through the dermis. May include full erosion of some parts of the nipple.
Recommended Treatment: As per Stage 3 above.
WHEN TO SEEK MEDICAL ASSISTANCE
While nipple damage can successfully be treated at home, there are occasions when it is necessary to see a doctor. A doctor should diagnose symptoms that continue to worsen and do not go away with treatment.
Sometimes, cracked nipples can get infected with bacteria (Staphylococcus aureus or ‘staph’), thrush (Candida albicans) or both. Signs of infection include redness, swelling, warmth, tenderness in the nipple and surrounding skin and possibly a fever with a temperature of 38oC or higher. In these cases, it is advisable to see a doctor.
Thanks for reading. If you have any questions or queries please feel free to leave a comment below. For more tips and advice on maternity skin care check out the Expert Advice section of the Natralogic website.
All the best
Lauren Lamont - Natralogic Founder
MSc Chemistry, Dip.Cos.Sci (SA)