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  • Reference list for Section 6: Lactation-related Nipple Pain and Wounds
  • Background, prevalence, and key to NDC management of nipple pain and damage in lactation
  • Signs and symptoms of nipple pain and damage during lactation
  • Lactation-related nipple pain or damage predisposes to other conditions
  • Don't miss a viral infection of the nipple-areolar complex or breast skin
  • Infant saliva is rich in protective immune and other factors
  • How nipple wounds heal

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  • S6: Lactation-related nipple pain + wounds
  • CH 1: Lactation-related nipple-areolar complex pain and wounds: prevalence, presentation, secondary effects

Reference list for Section 6: Lactation-related Nipple Pain and Wounds

Dr Pamela Douglas6th of Jul 202423rd of Dec 2025

x

  1. Barrett ME, Heller MM, Stone HF, Murase JE. Dermatoses of the breast in lactation. Dermatologic Therapy. 2013;26:331-336.
  2. McClellan HL, Hepworth AR, Garbin CP, Rowan MK, Deacon J, Hartmann PE, et al. Nipple pain during breastfeeding with or without visible trauma. Journal of Human Lactation. 2012;28(4):511-521.
  3. McClellan HL, Kent JC, Hepworth AR, Hartmann PE, Geddes DT. Persistent nipple pain in breastfeeding mothers associated with abnormal infant tongue movement. International Journal of Environmental Research and Public Health. 2015;12:10833-10845.
  4. Barrett ME, Heller MM, Stone HF, Murase JE. Dermatoses of the breast in lactation. Dermatologic Therapy. 2013;26:331-336.
  5. O'Hara M. Bleb histology reveals inflammatory infiltrate that regresses with topic steroids: a case series. Breastfeeding Medicine. 2012;7 (Suppl 1):S2.
  6. Mitchell K, Eglash A, Bamberger E. Mammary dysbiosis and nipple blebs treated with intravenous daptomycin and dalbavancin. Journal of Human Lactation. 2020;36(2):365-368.
  7. Mitchell K, Johnson HM. Breast pathology that contributes to dysfunction of human lactation: a spotlight on nipple blebs. Journal of Mammary Gland Biology. 2020:http://doi.org/10.1007/s10911-10020-09450-10917.
  8. Drago F, Gariazzo L, Cioni M. The microbiome and its relevance in complex wounds. European Journal of Dermatology. 2019;29(1):6-13.
  9. Dodd V, Chalmers C. Comparing the use of hydrogel dressings to lanolin ointment with lactating mothers. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2003;32(4):486-494.
  10. Mohammadzadeh A, Farhat A, Esmaeily H. The effect of breast milk and lanolin on sore nipples. Saudi Medical Journal. 2005;26(8):1231-1234.
  11. Whitehead F, Giampieri S, Graham T, Grocott P. Identifying, managing and preventing skin maceration: a rapid review of the clinical evidence. Journal of Wound Care. 2017;26(4):159-165.
  12. Rippon MG, Ousey K, Cutting KF. Wound healing and hyper-hydration: a counterintuitive model. Journal of Wound Care. 2016;25(2):68-75.
  13. Oousey K, Cutting K, Rogers AA. The importance of hydration in wound healing: reinvigorating the clinical perspective. Journal of Wound Care. 2016;25(3):122-130.
  14. Sams-Dodd J, Sams-Dodd F. Time to abandon antimicrobial approaches in wound healing: a paradigm shift. Wounds: a compendiu of clinical research and practice. 2018.
  15. Dos Santos ALS, Gladino ACM, De Mello TP. What are the advantages of living in a community? A microbial biofilm perspective! Mem Inst Oswaldo Cruz 2018;113(9):e180212.
  16. Dennis C, Jackson K, Watson J. Interventions for treating painful nipples among breastfeeding women. Cochrane Database of Systematic Reviews. 2014(12):doi:101.1002/14651858.CD14007366.pub14651852.
  17. Kirk AHP, Yang J, Sim WC, Chia LYX, Lau Y. Systematic review of the effect of topical applicatio of human breast mimlk on early umbilical cord separation. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2019;48(2):121-130.
  18. Jackson KT, Dennis C-L. Lanolin for the treatment of nipple pain in breastfeeding women: a randomized controlled trial. Maternal and Child Nutrition. 2017;13(3):e12357.
  19. Abou-Dakn M, Fluhr JW, Gensch M, Wockel A. Positive effect of HPA lanolin versus expressed breastmilk on painful and damaged nipples during lactation. Skin Pharmacol Physiol. 2010;2011(24):27-35.
  20. 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.
  21. Dennis C-L, Schottle N, Hodnett E, McQueen K. An all-purpose nipple ointment versus lanolin in treating painful damaged nipples in breastfeeding women: a randomized controlled trial. Breastfeeding Medicine. 2012;7(6):473-479.
  22. Olsen N, Nielson SL. Prevalence of primar Raynaud's phenomenon in young females. Scand J Clin Lab Invest. 1978;37(761-776).
  23. Anderson JE, Held N, Wright K. Raynaud's phenomenon of the nipple: a treatable cause of painful breastfeeding. Pediatrics. 113;113(4):e360.
  24. Pawlaczyk M, Lelonkiewicz M, Wieczorowski M. Age-dependent biomechanical properties of the skin. Postep Der Alergol. 2013;5:302-306.
  25. Tepole AB, Gosain AK, Kuhl E. Stretching skin: the physiological limit and beyond. International Journal of Non Linear Mechanics. 2012;47(8):938-949.
  26. Ventura AK, Lore B, Mireles O. Associations between variations in breast anatomy and early breastfeeding challenges. Journal of Human Lactation. 2020:doi:10.117/10890334420931397.
  27. Vazirinejad R, Darakhshan S, Esmaeili A, Hadadian S. The effect of maternal breast variations on neonatal weight gain in the first seven days of life. International Breastfeeding Journal. 2009;4(13).
  28. McClellan HL, Kent JC, Hepworth AR, Hartmann PE, Geddes DT. Persistent nipple pain in breastfeeding mothers associated with abnormal infant tongue movement. International Journal of Environmental Research and Public Health. 2015;12:10833-10845.
  29. Barrett ME, Heller MM, Fullerton H, Murase JE. Primary Herpes Simplex Virus infection of the nipple in a breastfeeding woman 2016.
  30. Odom E, Scanlon K, Perrine C, Grummer-Strawn L. Reasons for earlier than desired cessation of breastfeeding. Pediatics. 2013;131:e726-732.
  31. Li R, B S, Chen J, Grummer-Strawn LM. Why mothers stop breastfeeding: mothers' self-reported reasons for stopping during the first year. Pediatrics 2008;122:S69-S76.
  32. Dias JS, Vieira TDO, Vierira GO. Factors associated to nipple trauma in lactation period: a systematic review. Revista Brasileira de Saude Materno Infantil. 2017;17(1):27-42.
  33. Buck ML, Amir LH, Cullinane M. Nipple pain, damage, and vasospasm in the first 8 weeks postpartum. Breastfeeding Medicine. 2014;9:56-62.
  34. Kent JC, Ashton E, Hardwick C, Rowan MK, Chia ES, Fairclough KA, et al. Nipple pain in breastfeeding mothers: incidence, causes and treatments. Inernational Journal of Environmental Research and Public Health. 2015;12:12247-12263.
  35. Bourdillon K, McCausland T, Jones S. Latch-related nipple pain in breastfeeding women: the impact on breastfeeding outcomes. British Journal of Midwifery. 2020;28(7):406-414.
  36. Puapornpong P, Paritakul P, Suksamarnwong, Srisuwan S, Ketsuwan S. Nipple pain incidence, the predisposing factors, the recovery period after care management, and the exclusive breastfeeding outcome. Breastfeeding Medicine. 2017;12:169-173.
  37. Feenstra MM, Kirkeby MJ, Thygesen M, Danbjorg DB, Kronborg H. Early breastfeeding problems: a mixed method study of mothers' experiences. Sexual and Reproductive Health. 2018;16:167-174.
  38. Dennis C, Jackson K, Watson J. Interventions for treating painful nipples among breastfeeding women. Cochrane Database of Systematic Reviews. 2014(12):doi:101.1002/14651858.CD14007366.pub14651852.
  39. Coca KP, Amir LH, Da Silva Alves MdR, Barbieri M, Marcacine KO, De Vilhena Abrao ACF. Measurement tools and intensity of nipple pain among women with or without damaged nipples: a quantitative systematic review. Journal of Advanced Nursing. 2018;75:1162-1172.
  40. Watkins S, Meltzer-Brody S, Zolnoun D. Early breastfeeding experiences and postpartum depression. Obstetrics and gynaecology. 2011;118:214-221.
  41. McClellan HL, Hepworth AR, Garbin CP, Rowan MK, Deacon J, Hartmann PE, et al. Nipple pain during breastfeeding with or without visible trauma. Journal of Human Lactation. 2012;28(4):511-521.
  42. Watkins S, Meltzer-Brody S, Zolnoun D. Early breastfeeding experiences and postpartum depression. Obstetrics and Gynecology. 2011;118:214-221.
  43. UCR C. UK Health Research Analysis 2014. London: Medical Research Council, 2014.
  44. Santos KJdS, Santana GS, Vierira TdO. Prevalence and factors associated with cracked nipples in the first month postpartum. BMC Pregnancy and Childbirth. 2016;16:209.
  45. Buck ML, Amir LH, Cullinane M, Donath SM, CASTLE study team. Nipple pain, damage and vasospasm in the first eight weeks postpartum. Breastfeeding Medicine. 2014;9:56-62.
  46. Amir LH, Bearzatto A. Overcoming challenges faced by breastfeeding mothers. Australian Family Physician. 2016;45:552-556.
  47. 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.
  48. Thompson RE, Kruske S, Barclay L, Linden K, Gao Y, Kildea SV. Potential predictors of nipple trauma from an in-home breastfeeding programme: a cross-sectional study. Women and Birth. 2016;29:336-344.
  49. Ventura AK, Lore B, Mireles O. Associations between variations in breast anatomy and early breastfeeding challenges. Journal of Human Lactation. 2020:doi:10.117/10890334420931397.
  50. Vazirinejad R, Darakhshan S, Esmaeili A, Hadadian S. The effect of maternal breast variations on neonatal weight gain in the first seven days of life. International Breastfeeding Journal. 2009;4(13).
  51. Quinn PT, Lofberg JV. Maternal herpetic breast infection: another hazard of neonatal herpes simplex. Medical Journal of Australia. 1978;2(9):411-412.
  52. Gupta S, Malhotra AK, Dash SS. Child to mother transmission of herpes simplex virus-1 infection at an unusual site. Journal of European Academy of Dermatology and Venereology. 2008;22(7):878-879.
  53. James SH, Whitley RJ. Treatment of herpes simplex virus infections in pediatric patients: current status and future needs. Clinical Pharmacology and Therapeutics. 2010.
  54. Barrett ME, Heller MM, Stone HF, Murase JE. Dermatoses of the breast in lactation. Dermatologic Therapy. 2013;26:331-336.
  55. Barrett ME, Heller MM, Fullerton H, Murase JE. Primary Herpes Simplex Virus infection of the nipple in a breastfeeding woman 2016.
  56. Dekio S, Kawasaki Y, Jidoi J. Herpes simplex on nipples inoculated from herpetic gingivostomatitis of a baby. Clin Exp Dermatol. 1986;11(664-666).
  57. Tepole AB, Gosain AK, Kuhl E. Stretching skin: the physiological limit and beyond. International Journal of Non Linear Mechanics. 2012;47(8):938-949.
  58. Pawlaczyk M, Lelonkiewicz M, Wieczorowski M. Age-dependent biomechanical properties of the skin. Postep Der Alergol. 2013;5:302-306.
  59. Douglas PS, Keogh R. Gestalt breastfeeding: helping mothers and infants optimise positional stability and intra-oral breast tissue volume for effective, pain-free milk transfer. Journal of Human Lactation. 2017;33(3):509–518.
  60. Douglas PS, Geddes DB. Practice-based interpretation of ultrasound studies leads the way to less pharmaceutical and surgical intervention for breastfeeding babies and more effective clinical support. Midwifery. 2018;58:145–155.
  61. Liu X, Cleary J, German GK. The global mechanical properties and multi-scale failure mechanics of heterogeneous human stratum corneum. Acta Biometerialia. 2016;43:78-87.
  62. McClellan HL, Kent JC, Hepworth AR, Hartmann PE, Geddes DT. Persistent nipple pain in breastfeeding mothers associated with abnormal infant tongue movement. International Journal of Environmental Research and Public Health. 2015;12:10833-10845.
  63. Olsen N, Nielson SL. Prevalence of primar Raynaud's phenomenon in young females. Scand J Clin Lab Invest. 1978;37(761-776).
  64. Anderson JE, Held N, Wright K. Raynaud's phenomenon of the nipple: a treatable cause of painful breastfeeding. Pediatrics. 113;113(4):e360.
  65. O'Hara M. Bleb histology reveals inflammatory infiltrate that regresses with topic steroids: a case series. Breastfeeding Medicine. 2012;7 (Suppl 1):S2.
  66. Mitchell K, Eglash A, Bamberger E. Mammary dysbiosis and nipple blebs treated with intravenous daptomycin and dalbavancin. Journal of Human Lactation. 2020;36(2):365-368.
  67. Mitchell K, Johnson HM. Breast pathology that contributes to dysfunction of human lactation: a spotlight on nipple blebs. Journal of Mammary Gland Biology. 2020:http://doi.org/10.1007/s10911-10020-09450-10917.
  68. Esfahani AM, Rosenbohm J, Reddy K. Tissue regeneration from mechanical stretching of cell-cell adhesion. Tissue Engineering and Regenerative Medicine. 2019;25(11):doi:10.1089/ten.tec.2019.0098.
  69. Drago F, Gariazzo L, Cioni M. The microbiome and its relevance in complex wounds. European Journal of Dermatology. 2019;29(1):6-13.
  70. Dodd V, Chalmers C. Comparing the use of hydrogel dressings to lanolin ointment with lactating mothers. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2003;32(4):486-494.
  71. Mohammadzadeh A, Farhat A, Esmaeily H. The effect of breast milk and lanolin on sore nipples. Saudi Medical Journal. 2005;26(8):1231-1234.
  72. Whitehead F, Giampieri S, Graham T, Grocott P. Identifying, managing and preventing skin maceration: a rapid review of the clinical evidence. Journal of Wound Care. 2017;26(4):159-165.
  73. Rippon MG, Ousey K, Cutting KF. Wound healing and hyper-hydration: a counterintuitive model. Journal of Wound Care. 2016;25(2):68-75.
  74. Oousey K, Cutting K, Rogers AA. The importance of hydration in wound healing: reinvigorating the clinical perspective. Journal of Wound Care. 2016;25(3):122-130.
  75. Sams-Dodd J, Sams-Dodd F. Time to abandon antimicrobial approaches in wound healing: a paradigm shift. Wounds: a compendiu of clinical research and practice. 2018.
  76. Kirk AHP, Yang J, Sim WC, Chia LYX, Lau Y. Systematic review of the effect of topical applicatio of human breast mimlk on early umbilical cord separation. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2019;48(2):121-130.
  77. Jackson KT, Dennis C-L. Lanolin for the treatment of nipple pain in breastfeeding women: a randomized controlled trial. Maternal and Child Nutrition. 2017;13(3):e12357.
  78. Abou-Dakn M, Fluhr JW, Gensch M, Wockel A. Positive effect of HPA lanolin versus expressed breastmilk on painful and damaged nipples during lactation. Skin Pharmacol Physiol. 2010;2011(24):27-35.
  79. 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.
  80. Dennis C-L, Schottle N, Hodnett E, McQueen K. An all-purpose nipple ointment versus lanolin in treating painful damaged nipples in breastfeeding women: a randomized controlled trial. Breastfeeding Medicine. 2012;7(6):473-479.

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Next up in Lactation-related nipple-areolar complex pain and wounds: prevalence, presentation, secondary effects

Background, prevalence, and key to NDC management of nipple pain and damage in lactation

breastfeeding woman

Introduction

Nipple pain and damage is common in breastfeeding women. But interventions for clinical problems such as breast inflammation and pain remain a research frontier.2, 3

  • The Neuroprotective Developmental Care Clinical Guidelines for lactation-related nipple pain and damage propose a new mechanobiological model of nipple pain and damage in breastfeeding.

  • NDC clinical guidelines address the common lactation-related problem of pain of the nipple-areolar complex, including of the nipple stroma (that is, structural connective tissue of the mammary papilla in which vasculature, ducts and nerve fibres are embedded).

  • Clinicians should maintain a high index of suspicion for viral infection (in particular, herpes simplex and also herpes zoster viruses) in breastfeeding women…

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Possums acknowledges the traditional owners of the lands upon which The Possums Programs have been created, the Yuggera and Turrbal Peoples. We acknowledge that First Nations have breastfed, slept with, and lovingly raised their children on Australian lands for at least 65,000 years, to become the oldest continuous living culture on Earth. Possums stands with the Uluru Statement from the Heart.