Interventions which don't help lactation-related nipple pain and wounds
The research is heterogenous but does suggest that prevention and early intervention are important for nipple pain
A 2025 meta-analysis by Jia et al of interventions for lactation0related nipple pain concluded that
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Prevention and early intervention are more effective than delayed help
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The research on this topic is heterogenous.
There's no evidence to show that silver nipple protectors help nipple wounds heal
As background, it's helpful to know that silver-containing dressings or topical agents have not been shown to improve skin wound healing or prevent infection. Multiple studies show that silver exhibits cytotoxicity and slows the action of both keratinocytes and fibroblasts, and can result in significant delays in epithelialisation in vitro.
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Advocates of silver caps for lactating women argue that silver ions are effective against common wound pathogens, including methicillin-resistant S aureus, because they adhere to bacterial cell membrane, penetrating cell wall and disabling enzymes.
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Charehsaz et al 2021 investigated the biocompatibility and antibacterial effects of silver nipple protectors through in vivo and in vitro experiments, finding that they are safe to use during breastfeeding.
What does the research tell us about the effectiveness of silver caps?
Nakamura et al 2025
A non-randomized comparative trial by Nakamura et al in 2025 compared 47 participants (94 nipples) using silver nipple protectors with a control group of 50 participants (100 nipples) from historical data.
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In the intervention group, women used silver nipple protectors from the immediate postpartum period (in the recovery room post-birth), wearing them continuously other than in the shower. They were observed until the day after either they reported or it was observed that their nipple trauma healed. Participants were instructed to nurse on both breasts. The mothers in the control group used lansinoh or expressed breast milk on their nipples.
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On day 4, the intervention group presented with less nipple trauma. That is, there was a significantly higher occurrence of patterns transitioning from mild erythema or swelling toward healing. Furthermore, the proportion of severe conditions like persistent scabbing or blistering was significantly lower in the intervention group, and the transition from blistering to scabbing was also significantly less frequent.
Notably, this study doesn't claim to show that silver caps help heal nipple pain or damage. But the study also doesn't convincingly show that silver caps help prevent nipple pain or damage when worn continuously from immediately after birth, because of the following methodological concerns.
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Data from the control group was obtained from 2018 research. That hospital closed, and the control group was compared with postpartum women in different hospital setting between September 2023 and March 2024. Aspects of care of lactating women that weren't measured may have altered, to explain the differences between groups.
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Participants were not exclusively breastfeeding. Formula or expressed human milk was provided via bottle as needed for the infant, or based on maternal preference. Some milk removals were by pumping.
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Mothers in the intervention group fed their babies less frequently (measured at 1.3 less feeds) on day 4. This decreased frequency of direct breastfeeding alone may explain the differences noted between groups.
Marrazzu et al 2015
In 2015, an Italian RCT randomised 40 women with nipple fissures to silver cap use or standard care. The latter included an unspecified fit and hold intervention by an International Board-Certified Lactation Consultant and topical application of expressed breast milk. No changes between groups were detected at day 2 but more rapid resolution of symptoms were reported with silver cap at days 7 and 15.
This study is methodologically weak because one popularly applied fit and hold intervention has been demonstrated to worsen nipple pain fourfold and it is not clear what approach to fit and hold was used by the IBCLCs used. Also, application of expressed breast milk only in the control group, without careful education concerning prevention of adherence of the nipple wound to the breast pad, may have exacerbated epithelial damage and delayed healing.
What is the NDC position re use of silver caps?
Some women find use of the silverette cups soothing if they have nipple pain or damage. They need to be informed of the risk of
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Over hydration and moisture-associated skin damage, making the nipples more likely to be damaged with microtrauma and mechanical pressures
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Pressure on the milk ducts, 60% of which lie in a three centimetre radius of the base of nipples. This may predispose to breast inflammation.
Once informed, women may decide to use the silverettes judiciously, for comfort on occasions when wearing a bra. Other women find their nipple is high enough to touch the top of the cup, even when using the largest, worsening discomfort or pain.
There's no evidence to show that breast shells help nipple wounds heal
The promoters of breast shells believe that they protects painful or damaged nipples and promote healing.
A 2004 study by Cadwell et al 2004 of 94 Latvian women with sore nipples, randomised into using breast shells combined with lanolin compared to usual care showed no benefit.
Some women find use of the breast shells soothing. They need to be informed that the same risks as occur with silverettes, above, apply to breast shells. Once informed, women may decide to use the breast shells judiciously, for comfort on occasions when wearing a bra.
There is no evidence to show that All Purpose Nipple Ointment resolves nipple pain or damage
All Purpose Nipple Ointment (APNO) contains:
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Mupirocin ointment 2%: 15 grams
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Betamethasone ointment 0.1%: 15 grams
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Miconazole powder to a concentration fo 2% miconazole.
Dr Jack Newman claims that APNO heals nipples, destroys bacteria and candida.
However, APNO
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Risks Moisture Associated Skin Damage
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Suppressing bacteria with mupirocin destabilises normal microbiome and may worsen dominance of certain resilient bacteria (such as S aureus) in the context of simultaneous steroid treatment
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Betamethasone suppresses inflammation, but inflammation is necessary for wound healing and for resolution of any microbial overgrowth.
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Miconazole treats Candida which has not been shown to cause nipple pain.
Canadian women with damage to one or both nipples were randomised into APNO and lanolin application groups. No significant difference were found in pain scores after one week. Women in lanolin group reported greater satisfaction with their infant feeding method.8
There's no evidence that other topical applications help
Lanolin, polymem and hydrogel
You can find out about lanolin, polymem and hydrogel, including when they may be useful and the risks associated with their use, here.
Honey
Honey has a antimicrobial, anti-inflammatory and antioxidant activity, and stimulates lymphocytic and phagocytic activity. However, honey applications risk overhydration and moisture-associated skin damage if applied to the nipples.
Petroleum-based products e.g. vaseline
Petroleum-based products risk overhydration and moisture-associated skin damage.
Salt water
Salt water causes pain and stinging, without benefit.
Steroid applications
Steroid cream or ointment e.g. betamethasone, mometasone, triamcinolone Reduces inflammation. Steroids fail to address repetitive mechanical micro-trauma which results in inflammation; disrupt healing inflammatory processes and may disrupt skin microbiome homeostasis; they may overhydrate and risk Moisture Associated Skin Damage.
There may be a role for topical steroid application with hyperkeratotic white spots and other skin conditions of the nipple, such as eczema.
Topical antiseptic
Topical antiseptic applications have cytotoxic properties which kill human cells, including newly formed tissue generated on periphery of and within wound, impeding wound healing. These should be avoided.
Zinc oxide
Examples of products which contain zinc oxide are desitin and sudacrem. Zinc oxide is sometimes mixed with cod liver oil. Promoters of zinc oxide propose that it will debride the nipple wound and protect epithelium. However, attempts to remove zinc oxide from nipple may exacerbate nipple damage and it's safety has not been established if ingested by infant. It should be avoided on nipples.
‘Natural’ nipple care products
Examples of natural nipple care products promoted for nipple pain and damage include calendula, kamillosan, juba, aloe vera, guaiazulene ointment, and p.oleracea. These risk epidermal overhydration and Moisture Associated Skin Damage, with no evidence of benefit.
Tea bag or hot water compress
Proponents of tea bag or hot water compresses claim this will increase blood flow, oxygen and nutrients. The Niazi et al systematic review claimed benefit of warm water compresses for nipple pain but the analysis is methodologically weak. Tea bag or hot water compresses should be avoided.
There's no evidence to suggest that sunlight or hairdryer air help nipple wounds heal
Too much direct sunlight can have an irritating and inflammatory effect on skin. It's best not to advise direct sunlight exposure on nipples, though modest incidental exposure is unlikely to harm. There's no reason to think that blowing air from a hairdryer on a nipple wound helps healing.
Recommended resources
Nipple pain in lactation: management summary
Nipple wounds in lactation: management, including exudate, scabs, and nipple rest
Nipple shields and breastfeeding support in the clinic
Interventions which don't help lactation-related nipple pain and wounds
Case study: Manon has nipple damage from the first week of her baby's life
Selected references
Cadwell K, Turner-Maffei C, Blair A, Brimdyr K, McInerney ZM. Pain reduction and treatment of sore nipples in nursing mothers. Journal of Perinatal Education. 2004;13(1):29-35.
Charehsaz, M., Reis, R., Sumer, E., Orak, D., Deniz, I., Sipahi, H., & Aydin, A. (2021). Assessment of dermal biocompatibility and antimicrobial activity of silver-made nipple cap. Journal of Research in Pharmacy, 25(5), 755–762. https://doi. org/10.29228/jrp.66
Iljas JD, Röhl J, McGovern JA, Moromizato KH, Parker TJ, Cuttle L. A human skin equivalent burn model to study the effect of a nanocrystalline silver dressing on wound healing. Burns. 2021;47(2):417-429. doi:10.1016/j.burns.2020.07.007
Jia X, Dong Y, Shen C. Interventions for breastfeeding-related nipple pain or injury: a meta-analysis. Frontiers in Global Women's Health. 2025(6:1507723.):DOI 10.3389/fgwh.2025.1507723.
Marrazzu A, Sanna MG, Dessole F, Capobianco G, Piga MD, Dessole S. Evaluation of the effectiveness of a silver-impregnated medical cap for topical treatment of nipple fissure of breastfeeding mothers. Breastfeed Med. 2015;10(5):232-238. doi:10.1089/bfm.2014.0177
Nakamura M, Sugimori H, Asaka Y, Ebina Y. Role of silver nipple protectors in treating nipple trauma: a non-randomized comparative trial. Journal of Human Lactation. 2025;41(3):382-391.
Niazi A, Rahimi VB, Soheil-Far S. A systematic review on prevention and treatment of nipple pain and fissure: are they curable? Journal of pharmacopuncture. 2018;21(3):139.