Why can’t you just tell yourself to stop scratching? Very simple: you never told yourself to start. Your conscious willpower self isn’t running the show.
Published On: Nov 1, 2021
Last Updated On: Nov 4, 2021
Breastfeeding a newborn can be difficult for anyone, but if you have eczema you may face additional challenges. According to Dr. Rupam Brar, assistant professor of pediatrics at the NYU Grossman School of Medicine, “Patients with underlying eczema may be more prone to discomfort while breastfeeding.” Problems can range from irritation to nipple dermatitis, which, according to Brar, “can cause erythema (redness), oozing, crusting and erosion of the areola.”
We asked Dr. Brar and Kelly Albertson, a pediatric N.I.C.U. feeding therapist based at New York Presbyterian Morgan Stanley Children’s Hospital, for their advice on breastfeeding with eczema.
Brar has several recommendations for preventing problems before they start. The first, and easiest, is applying expressed breast milk to the nipples. Edible oils can also be used for this purpose.
You may have been told to use lanolin for nipple discomfort, but Dr. Brar does not recommend it for women with eczema since it can cause flares. Brar said, “I recommend sunflower oil, which has natural anti-inflammatory properties.” She noted that coconut oil, olive oil and raw shea butter can also be used. These interventions can also help if your nipples are already irritated.
Brar also stressed the importance of making feedings as efficient as possible, to minimize the possibility of nipples becoming irritated. Be sure your baby has a good latch, remember to drink enough water and try applying heat to your breasts before nursing or pumping to encourage the let-down reflex.
If you do develop sore nipples, or nipple dermatitis, take heart – even though these problems may be painful, they are not impossible to treat.
Dr. Brar recommended first consulting with a healthcare professional to rule out the possibility of a fungal infection. If you have one, an antifungal medication may be prescribed.
To reduce discomfort, Albertson recommends using nipple shields while breastfeeding. However, she cautioned that some women find them frustrating because they can slip. She also noted, “The other issue with nipple shields is making sure the baby still has a proper latch because if not, it could cause further nipple damage.”
Albertson also recommended hydrogel pads. They can help to reduce pain, stop scabs from forming and speed healing.1 Be sure to use dressings that do not have adhesive backings, as they can stick to the nipples.1
Medications can be helpful for more severe cases. Dr. Brar explained that pain relievers or non-steroidal anti-inflammatory drugs (NSAIDs) can work.
If you have nipple dermatitis that doesn’t respond to other interventions, you may have no other option than applying topical corticosteroids to your nipples directly.
When Wendy Chacon, who lives with eczema and has four children, had her first baby, she was concerned about her newborn coming into contact with her topical corticosteroids. She said, “It was a constant worry.”
Chacon was right to be concerned. Topical corticosteroids have been known to cause hypertension and growth delays in infants who were consistently exposed to potent doses through skin-to-skin or oral contact over time.2-3 However, there are steps to minimize transfer to the baby: use as little ointment as possible, and apply it directly after a feeding. This allows enough time (at least one hour) for the medicine to be absorbed.4 Also be sure to wipe the ointment off before nursing again.5
Be sure to consult with your healthcare provider before trying any new medicines.
It is important to balance your needs with your baby’s. While breastfeeding is widely recommended, Albertson noted, “At the end of the day fed is best, it doesn’t matter the method. It could be direct breastfeeding, pumped milk in a bottle, 50/50 breast milk and formula or just formula. Whatever works for you will work for your baby.”
Dr. Brar agreed: “It’s important for moms to self-care and manage their own discomfort so they can continue to be nurturers to their baby in this important time of bonding.”
Chacon advised new mothers to focus on their relationship with their babies. She said, “Enjoy the connection with your baby. Don’t let eczema rob you of that special moment.”
1. Walker M. Are there any cures for sore nipples?. Clin Lact 2013;4(3). doi:10.1891/2158-0718.104.22.168
2. De Stefano P, Bongo IG, Borgna-Pignatti C, Severi F. Factitious hypertension with mineralocorticoid excess in an infant. Helv Paediatr Acta. 1983;38(2):185-9. PMID: 6874387.
3. Topical corticosteroids. National Health Service. Updated January 15, 2020. Accessed September 8, 2021. https://www.nhs.uk/conditions/topical-steroids/
4. Van Onselen J, Moulds C. Baby on board. National Eczema Society. March 2021. Accessed September 8, 2021. https://eczema.org/information-and-advice/living-with-eczema/pregnancy-and-eczema/
5. Mometasone, Topical. Drugs and Lactation Database (LactMed). National Library of Medicine (US). Updated January 18, 2021. Accessed September 8, 2021. https://www.ncbi.nlm.nih.gov/books/NBK501037/#