Introduction

Nipple fissures are referred to as dry and irritated cracks on the nipple skin, often caused during breastfeeding. The skin around the nipple is very sensitive and is prone to irritation due to suction when breastfeeding or even due to friction with clothing. An average of 80% of women who breastfeed experience nipple fissures and pain around the nipples.¹ This makes breastfeeding the number one cause of nipple fissures. Nevertheless, breastfeeding women who experience dry skin, trauma, and infection in the nipples are more prone to developing these fissures.² If left untreated, it can cause severe pain and bleeding, which will affect milk secretion; therefore, breastfeeding can be disturbed.³ In this article, we will explore how dry skin may contribute to nipple fissures and understand the importance of moisturisers in hydrating the skin to heal and prevent nipple fissures from forming. 

Understanding nipple fissures

As mentioned, the main causes of nipple fissures are associated with breastfeeding; however, friction in the area also plays a big role in causing fissures. During breastfeeding, the nipple and surrounding breast tissues stretch because of the suction created by the baby. This suction happens when the baby’s lower jaw moves down while keeping a tight seal on the breast.⁴ However, in some cases, an improper latch happens when the baby doesn’t attach to the breast in the right way. Instead of taking in both the nipple and a good amount of the areola, the baby may only latch onto the nipple, which causes problems such as nipple fissures.⁵ Incorrect form of breastfeeding affects both the mother and the baby, as the baby, whilst the mother experiences pain, bleeding and burning because of the fissures, the baby is affected if the milk supply is insufficient.  

Nipple fissures impact the quality of life of women due to the symptoms caused by these fissures, risks of infections and other health problems. One of the main symptoms of these fissures is pain and irritation. Nipple pain is a troubling sensory and emotional experience that can disrupt a mother’s mood, daily activities, and sleep and even increases the risk of postnatal depression.⁶ Nevertheless, there is a risk of mastitis, which is an infection that affects women who are breastfeeding. According to the World Health Organisation (WHO), approximately 33% of breastfeeding women experience mastitis worldwide.⁷ Some of the reasons this infection occurs are due to cracks produced by nipple fissures, making the skin more susceptible to bacteria entering the skin. Other factors include improper latching of the baby and insufficient removal of milk from the milk ducts of a breastfeeding woman.⁸  

Dry skin is a contributing factor

Although many reasons contribute to the formation of nipple fissures, women who have dry skin have an increased chance of developing fissures. Characteristics of dry skin include:

• Skin that is not moisturised
• Has a loss of elasticity 
• Rough and flaky texture
• Loss of natural oils 
• Dull appearance 
• Red and irritated⁹

Dry skin equates to a damaged skin barrier, which leads to the development of fissures and other skin conditions such as eczema. A study looked at how breastfeeding habits changed from birth to 6–8 weeks, and found that many mothers who had nipple redness or eczema were more likely to change how they fed their baby, whereas those with nipple cuts or wounds were more likely to stop breastfeeding earlier than expected.¹⁰ Having dry skin characteristics interferes with breastfeeding and makes you more prone to developing fissures due to decreased barrier function and delayed healing of the skin. 

Role of hydration in skin health

Hydrating the skin is very important in terms of skin health, and this includes internal and external hydration of the skin. In terms of internal hydration, this term refers to adequate water intake of the body. Approximately, up to 70% of the body's weight is made up of water, which means that water is essential to maintain healthy skin.¹¹ Inadequate water intake will not only affect the health of the body, but will also affect the moisture levels of the skin. Nevertheless, there is a clear relationship between the water content in the body and its impact on the skin barrier, as well as other dermatological conditions.

External hydration refers to hydrating the surface of the skin using moisturisers. Moisturisers come in the form of lotions and creams, and they are generally water-based, that is applied topically on the skin. Ingredients in these moisturisers are key molecules such as urea and glycerol, which are referred to as natural moisturising factors (NMF), and their role is to replace water in dehydrated skin.¹² Therefore, the ingredient content of the moisturiser is very important; not all moisturisers have ingredients that hydrate the skin and improve the skin barrier. Specifically, dermatologically tested moisturisers sold in pharmacies are the best option as they cater for each skin condition, from nipple fissures to conditions like dermatitis.

Importance of moisturisers

As mentioned before, moisturisers play an important role in maintaining moisture levels of the skin, improving the skin barrier and soothing irritation. There are different types of moisturisers that each have a function in hydrating the skin. 

• Types of Moisturisers
  • Occlusives: Occlusives, like petroleum jelly, are made up of oils, and they help keep your skin from drying out. They work by forming a protective layer on the skin that locks in moisture and maintains a good level of water content in the skin, which helps the skin stay hydrated and smooth, especially in dry or cold weather¹³
  • Humectants: Humectants such as glycerol and hyaluronic acid attract water into the outer layer of your skin. They attract moisture from deeper layers of the skin or from the air, specifically in a humid environment¹⁴ 
  • Emollients: Lanolin is a type of emollient that works by filling the cracks of dry and damaged skin cells, making the skin feel smoother and softer. It is the most common emollient used in treating nipple fissures

Prevention and treatment strategies

Preventing dry skin by regular moisturising and avoiding using harsh soaps that irritate the skin will reduce the chances of developing nipple fissures. Wearing breathable underwear and choosing gentle and non-abrasive fabrics such as cotton is the best way to prevent nipple fissures. Breast milk is seen as a natural remedy to treat nipple fissures due to its anti-inflammatory and antibacterial characteristics; however, there is a longer healing process in comparison to other treatment types.¹⁵

On the other hand, the most common form of treating nipple fissures is by using lanolin-based moisturisers. It is a natural form of animal fat used to treat sore and cracked nipples of breastfeeding women; however, people allergic to wool should avoid using lanolin as it is derived from sheep’s wool.¹⁶  Other forms of supporting treatment include cleaning the area frequently, maintaining internal hydration and using a general moisturiser frequently. Treating underlying dry skin or skin conditions is also a preventive measure. Nevertheless, other preventive measures could be taken when breastfeeding; educating new mothers on correct latch and positioning of the baby can help prevent nipple fissure formation. 

FAQs

How do you treat a fissure on your nipple?

Lanolin is the most common form of treating nipple fissures, as well as other moisturising agents.

How to remove dead skin from nipples?

You can clean the area thoroughly with warm water and cotton balls. 

Is it better to moisturise in the morning or at night?

It is better to moisturise at night as skin is more permeable. 

Is it good to let your skin breathe without moisturiser?

If you are experiencing dry skin, it is recommended that you keep moisturising. 

How can I moisturise my breast skin?

You can use moisturisers on your nipples, areolas and around the breast skin.    

Summary

Dry skin increases the chances of developing nipple fissures; therefore, it is always important to moisturise the nipples prior to breastfeeding. Keeping the skin moisturised and hydrated both internally and externally impacts skin health. However, there are environmental factors that also play a part in affecting skin health; living in dry climates or humid environments can dehydrate the skin. Keeping these factors in mind and taking preventative measures depending on your situation can help maintain healthy skin.