Fissure in the nipple: why it happens and how to care for it during breastfeeding Credit: Disclosure A fissure in the nipple is one of the most frequent complaints among women who are breastfeeding, especially in the first few weeks after giving birth. Pain when offering the breast, the burning sensation and the appearance of cracks or small wounds in the nipple and areola region can make breastfeeding a difficult time, and in some cases lead to early weaning. Most of these situations can be resolved with adjustment of technique and local care. Dermatological ointments such as Millar are used to protect and recover injured skin in the breast region, and are part of the fissure management guidelines in health units and maternity wards. What is a fissure in the nipple? A fissure is an injury to the skin of the nipple or areola. It can appear as a small crack, superficial erosion or a more extensive wound, depending on the intensity and time it takes without treatment. The skin around the nipple area is delicate and is subject to constant friction during feedings. When this friction occurs inappropriately, mainly due to the baby's incorrect attachment, the skin is unable to regenerate between feedings and begins to break down. Why does the fissure appear? The most common cause is the baby's incorrect attachment to the breast. When the baby does not grasp a sufficient portion of the areola and only sucks on the nipple, the pressure concentrates on one point, which progressively hurts the skin. Other factors that contribute to the appearance of fissures include: use of extraction pumps with inadequate pressure regulation dry skin due to weather conditions or low hydration nipple retraction, which makes latching difficult short lingual frenum in the baby, which limits the movement of the tongue during sucking In some cases, the combination of more than one factor worsens the condition and prolongs healing time. "One of the recommendations is that the mother should be monitored to correct the baby's latch, especially first-time babies. By correcting the latch, it is possible to avoid or even make the craving even worse", comments Eliane Messias, pharmacist responsible for Rede Drogal. How to identify the crack The most common signs are: severe pain during and after feedings burning or burning sensation in the nipple area presence of visible cracks, erosions or crusts light bleeding in more advanced cases localized redness Pain during breastfeeding is not normal and should not be treated as inevitable. When it persists beyond the first few suctions, it is a sign that something needs to be adjusted. The role of correct attachment in prevention and recovery Correcting the latch is the most important step in both preventing the fissure and allowing it to heal. As long as the baby continues to suck incorrectly, the injury tends to worsen even with the use of ointments. When latching properly, the baby should be facing the breast with the entire body facing the mother, the mouth wide open and the tongue under the areola. The lower lip should be facing outward. The mother should not feel pain after the first sucks. Lactation consultants, obstetric nurses and pediatricians can observe a feeding and identify what needs to be corrected. Local treatment: what to use on the fissure Topical treatment aims to protect the injury, reduce friction and create conditions for healing. Purified lanolin is one of the most studied substances for this purpose. It forms a protective barrier over injured skin, retains moisture and does not need to be removed before feedings, which prevents additional trauma. HPA lanolin-based ointments, such as Lansinoh, are specifically formulated for use on nipples and are considered safe for the baby while breastfeeding. After each feeding, a small amount of the product can be applied to the injured area. It is not necessary to clean the nipple before the next feeding. Fissure in the nipple: why it happens and how to care for it during breastfeeding Credit: Disclosure Vitamin E and skin recovery Vitamin E is known for its role in skin health and the body's antioxidant responses. It participates in the cell regeneration process and can be found both in forms for topical use and in supplements. Products with vitamin E available in pharmacies are sought after by women seeking support for skin recovery during breastfeeding. Before using any product in the nipple area, it is worth confirming with a healthcare professional whether the chosen formulation is indicated for this use during lactation. What to avoid during treatment Some common practices can delay healing: washing your nipples with soap several times a day, which dries out the skin using wet breast pads for long periods without changing apply alcohol or strong antiseptic products to the lesion stopping breastfeeding without guidance, which can lead to engorgement and worsen the condition Breast milk has antibacterial properties and can be applied directly to the nipple after feedings as a complementary resource to treatment. When to seek care Some signs indicate that the fissure may have evolved into a complication that requires in-person evaluation: fever above 38 degrees accompanied by pain and redness in the breast hardening of an area of the breast, with local heat secretion with an odor different from milk pain that does not improve even after latch correction injury that does not heal in more than two weeks These signs may indicate mastitis, an inflammation of the breast that may or may not have an infectious origin and treatment is available. Fissure in the nipple can be treated and does not require weaning A fissure in the nipple is painful, but in most cases it responds well to a set of technique adjustments, local care and professional monitoring. Early weaning due to pain is common, but can generally be avoided when the woman receives adequate guidance from the first hours after giving birth. Seeking support from a professional specialized in breastfeeding makes a difference in recovery time and continued breastfeeding. What vitamins are recommended for women who are breastfeeding? Eliane Messias Rodrigues, responsible pharmacist for Drogal. CRF/SP 43,895