Key management principle #2. Minimise epidermal overhydration and moisture-associated skin damage for prevention and management of nipple pain and wounds

There is no evidence to suggest that topical applications to the nipple during lactation prevent pain and damage or improve healing

A range of topical applications on nipples during lactation have been shown to be ineffective for the healing of nipple pain and damage, including

• Anti-fungal treatments

• Mupirocin antibiotic cream

• Hydrogel discs

• Lanolin

• Vitamin A and E

• Vaseline

• Sundry emollients, and

• ‘All Purpose Nipple Ointment’.

You can read the research on these preparations here.

In addition, moist preparations increase the risk of epithelial overhydration and moisture-associated skin damage (MASD). You can find out about this here.

Why it's important to educate women about the risks of overhydration and moisture-associated skin damage when they have nipple pain and wounds

Here are the reasons why every breastfeeding or lactating women has the right to be informed about the risks of overhydration and moisture-associated skin damage.

• Overhydration and MASD places the nipple-areolar complex at

  • Increased risk of pain and damage, and

  • Increased risk of damage or delayed healing.

• Overhydration and MASD may be confused with an irritant contact dermatitis or an allergic contact dermatitis.1 - MASD results in an erythematous rash with clearly defined edges visible on the areola, corresponding with topical application.

Environmental humidity from occlusion, including from a bra and breastpad, alters skin pH and microbiome, and hydrates the epithelium. This interferes with the cohesive strength of the desmosomes, resulting in worsened epidermal deformation, increased length of crack propagation pathways, secondary crack formation, and oblique crack interfaces in the stratum corneum.

You can review the evidence concerning moist wound healing of nipples during lactation here.

Selected references

Khattak S, Ullah I, Yousaf M. Advancements in hydrogels: a comprehensive review of natural, synthetic, and hybrid innovations for wound healing. International Journal of Biological Macromolecules. 2025;327:147270.