Should Mothers With Nipple Eczema Breastfeed?

Are there breastfeeding benefits or infant risks when suffering from Paget’s disease?

DERMATOLOGY If you are considering breastfeeding but have nipple eczema or mammary Paget's disease, ask your doctor what can be done before giving birth, when possible.

Viewer Discretion: Breastfed babies enjoy numerous health benefits. Breast milk is rich in the nutrients that best promote brain growth and nervous system development. Only breast milk contains the many different kinds of disease-fighting factors that help prevent various infections. Breast milk is the most easily digested food your baby can receive and your baby effectively absorbs more nutrients. Finally, breast milk is gentler on baby's systems, making them less prone to adverse skin conditions and asthma[1] Breastfeeding is not just a way of nourishing your baby (though it is undoubtedly the very best way to do that). It's also about a relationship; it's about security; and it's about loving. [2]

Breastfeeding may depend upon which condition is diagnosed.

Are all the benefits negated when a woman has eczema or Paget's disease? First it's important to obtain an accurate diagnosis. Whether breastfeeding is possible depends upon which condition is diagnosed. The two appear similar. Eczema (atopic dermatitis) is commonly contracted by mothers after beginning breastfeeding. Paget's disease is an uncommon intraductal carcinoma, representing 5% of all breast cancers. [3] Hence, surgery, chemotherapy or radiotherapy may be necessary. Cancer treatment will affect possibility of breastfeeding.

Symptoms Paget's Disease and Eczema

Paget's Disease Nipple

The main symptoms of Paget's disease are flaky or scaly skin on the nipple, beige or bloody nipple discharge. Nipple flattening or other skin and nipple changes in only one breast may occur. Patients may also experience crusty, oozing or hardened skin resembling eczema, on the nipple, areola or both. Some patients complain of burning sensations in later stages. [4]

Similarly, eczema may produce an itchy rash anywhere on the body, including the breast, areola or nipple. There may be crusty, weepy or hardened skin and irritation. Eczema appears to have a predilection for persons with history of asthma or hay fever. [4] Onset of symptoms occur more commonly at 5 or 6 months postpartum and are associated with infant teething or the introduction of solids or as a delayed hypersensitivity to an allergen in a product on the skin. [5]

Treating Eczema

The following suggestions have proved helpful for some patients:

  • Avoid hot showers
  • Prevent harsh soap or shampoo from getting on nipples
  • Eschew any non-prescribed products on nipples except ultra-purified lanolin
  • Shower after swimming
  • Moisturize nipples with ultra-purified lanolin or sorbolene after shower or bath

Consult your physician before lactation begins if there is evidence of nipple irritation. Topical corticosteroids are the main method of treatment. Apply sparingly after breastfeeding or as directed. Ointment is preferred as it is absorbed before the next breastfeed. [6] For severe cases of eczema, the skin around the nipple should be cleaned with warm water to remove all traces of topical ointment medication. Breast milk can then be expressed, pre-boiled and spoon fed to the infant. [7]

Nipple Shields

Some mothers find nipple shields helpful. A nipple shield is thin, flexible silicone used to cover the mother's nipple and areola during nursing. Two problems with shields are that stimulation is lessoned, which can lead to reduction in milk supply (less milk for baby and risk of plugged ducts). Also, the baby is being taught to latch on to the nipple shield rather than the breast. So weaning from the shield can be difficult. For these reasons, it is best to work directly on resolving the problem rather than reaching for nipple shields as the first line of defense. However, under the guidance of a lactation consultant, it is better to have a baby on the breast with a shield (as a short-term solution) than not on the breast at all. [8]

Tags: dermatosis, dermatology, emollients, mammary glands, precancer, pregnancy

References
  1. Breastfeeding: Benefits of mother's own milk. childrenshospital.org ^
  2. It's time to stop knocking breastfeeding. guardian.co.uk ^
  3. Paget Disease of the Nipple. cancer.gov ^
  4. Paget's disease of the breast. wikipedia.org ^
  5. Atopic dermatitis (eczema). mayoclinic.com ^
  6. Nipple Eczema Dermatitis. thewomens.org.au ^
  7. Is Breastfeeding With Nipple Eczema Harmful? iibc.com ^
  8. Nipple Shields. kellymom.com ^
  9. Eczema in pregnancy. bmj.com ^


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