How Dermatologists Can Support Breastfeeding Mothers: And Why They Should

Picture it—a new mom in the hospital after she has just delivered her first child. Soon enough, baby is ready to go home, and she is too—or so she thinks. Her primary team identifies a rash on her breast, is concerned about an infection, and do not want the baby to nurse until a diagnosis is established. When the rash does not respond to antibiotics, a dermatology consult is placed. The dermatologist identifies a contact allergy from the lanolin-based emollient she has been using, and the rash clears quickly, but not before her baby is discharged. This scenario (based on one of many true stories) highlights the value of dermatology in a postpartum care team and the importance of breast health education.

Although breastfeeding has numerous well-studied advantages to both mothers and infants, the rates of breastfeeding are far below goal. A majority of nursing mothers experience nipple pain as well as sore, cracked, or bleeding nipples, which have been cited as reasons for early cessation of breastfeeding and inability to meet breastfeeding goals. ¹ Pain during breastfeeding has been associated with depression and anxiety, which also lead to breastfeeding cessation. ² Even though many women experience nipple problems while breastfeeding, proper treatment is not well known.

A few common remedies that women use to treat nipple pain are peppermint oil and lanolin. However, peppermint oil has a drying effect and can weaken the skin. ² Lanolin, which is extracted from wool, has been used in cosmetic products and topical medications for years. Unfortunately, many people develop hypersensitivity reactions to lanolin, including as many as 6.9% of people with atopic dermatitis. ³

Common dermatoses that occur on breasts while nursing that cause erythematous, cracked, pruritic, or painful nipples include psoriasis, atopic dermatitis, allergic contact dermatitis, irritant contact dermatitis, and bacterial, yeast, and herpes simplex virus infections. ⁴ Although most pregnant and postpartum women are evaluated by nursing staff and lactation consultants, very few are seen by dermatologists. ² Dermatologists can play a crucial role in diagnosing and treating these conditions and should especially be consulted when the diagnosis is not clear or does not respond to therapy.

For example, if a patient presents with dermatitis, dermatologists can ask a thorough history about the use of skincare products, look at the pattern of the rash to determine the type of dermatitis, and provide appropriate recommendations. Dermatologists can also play a role in preventive care by obtaining a thorough dermatological history before patients begin breastfeeding, since history of dermatological conditions can predispose patients to dermatoses while lactating. ²

For example, one study aimed to find an association between nipple pain and pruritus during breastfeeding in women who were 6 to 8 weeks postpartum, history of dermatological conditions, and breastfeeding outcomes. This study found that women who pumped or had postpartum erythema or atopic dermatitis were more likely to change their feeding practices, usually by discontinuing exclusive breastfeeding and by incorporating pumping and/or formula feeding. These women were also more likely to have had a history of atopic dermatitis or sensitive skin. ² Dermatologists can counsel these women about their increased chances of developing an atopic dermatitis flare while breastfeeding and have scheduled visits with them during their breastfeeding journey.

Dermatologists can also prescribe appropriate treatment for these dermatoses and follow-up to ensure resolution. For dermatitis, low potency steroids are used for mild cases, while moderately potent steroids are used for severe cases, twice a day for ∼2 weeks.^4,5 Steroids should be applied after feeding and should be wiped off before breastfeeding to prevent steroid exposure to the infant. ⁵ Dermatologists can also prescribe second- or third-line treatments for dermatoses on a case-by-case basis as they are knowledgeable about various cutaneous medications and their side effects. They can play an integral role in encouraging new mothers to breastfeed, ultimately leading to excellent benefits for mothers and babies.