Nipple Pain, Itching & Rashes: Could It Be a Nipple Yeast Infection?

What does it mean when you have nipple pain, itching or rashes?

Nipple pain, nipple itching and a nipple rash are common symptoms of many different issues you might experience while breastfeeding. You might be wondering, why does my nipple itch? Or, why do I have a rash on my nipple? Talking to other parents or searching online may make you worry that you have a nipple yeast infection.

It’s important to clear up one misconception right away. Yeast isn’t to blame. Recent research shows there’s little to no evidence that yeast infections can even occur on your nipple. Instead, the most up-to-date research shows that other factors cause these symptoms. These factors include things like improper latch and positioning, irritants and allergens.

If you’re breastfeeding and begin to have pain, itching or rashes, the first thing to do is contact a lactation consultant or breastfeeding medicine specialist. Lactation consultants are certified health professionals who specialize in breastfeeding issues. Breastfeeding medicine specialists, also called breastfeeding physicians, are medical doctors with advanced training in breastfeeding management and related disorders.

Your provider will be able to find the cause of your symptoms and help you receive the appropriate treatment.

What is a nipple yeast infection?

A nipple yeast infection is a diagnosis of a specific type of fungus (Candida albicans) on your nipple. Many breastfeeding parents have received this diagnosis over the years. But now, the latest research shows this diagnosis is incorrect. There’s no solid evidence to prove that yeast infections cause the pain and itching typically associated with them.

Traditionally, healthcare providers diagnosed a nipple yeast infection (also called “nipple thrush” or “mammary candidiasis”) based on how it looked. They’d look for signs like redness, cracked skin or swelling around the nipples. They’d also ask about symptoms like shooting pain or itching. Taken together, these signs and symptoms would often lead to a diagnosis of a nipple yeast infection.

The traditional treatment for an apparent nipple yeast infection included topical antifungal creams and sometimes oral antifungal medication. Sometimes, these treatments seem to work. That’s because antifungal medications help reduce inflammation, even if fungus isn’t the cause. So, they might ease your symptoms for a bit.

But the relief in such cases is temporary. You or someone you know might keep having “recurrent” nipple yeast infections, when really, it was never a yeast infection to begin with. The symptoms keep coming back because the treatment isn’t addressing the actual root cause.

Could I have a yeast infection of the nipple?

The latest evidence points to “no.” Research shows that nipples aren’t an area where yeast typically grows. Instead, yeast might grow in the skin folds of your breast, including the undersides of your breast or near your armpit.

You may face a higher risk of yeast infections in these areas if you have diabetes, obesity or a compromised immune system. Treatment usually includes topical antifungal medications (like nystatin cream). Rarely, you may need oral antifungal medication (fluconazole).

These treatments aren’t appropriate for nipple pain, itching and rashes around your nipple. This is because other causes — not yeast — are responsible.

Using antifungals when you don’t have a fungal infection can do more harm than good. For example, they may irritate your nipple and make your symptoms worse. Gentian violet, in particular, can cause ulceration of your nipple and mouth ulcers in your nursing baby. Using antifungal medications when you don’t need them also contributes to the global problem of antimicrobial resistance.

What are the most common causes of nipple pain, itching and rashes?

If a nipple yeast infection isn’t to blame, then what is? The latest research shows the following conditions are often the culprits:

Dermatitis

Dermatitis is an umbrella term for many different conditions that cause skin inflammation.

When breastfeeding, you may develop contact dermatitis. This is when something irritates your nipples or causes an allergic reaction. Allergic reactions may make your nipples very itchy, while irritations typically cause stinging and pain.

Many different substances and materials can cause contact dermatitis, including:

• Nipple balms or creams.
• Breast pads.
• Nursing bras.
• Soaps or detergents.
• Parts of your breast pump.
• Substances your baby touches or eats (which then transfer from their mouth to your nipple during breastfeeding).
• Antifungal creams, which you may receive to treat an apparent nipple yeast infection.

Atopic dermatitis (eczema) can also occur while you’re breastfeeding. You’re more likely to develop this condition if you have a history of eczema or psoriasis.

Nipple blebs

Also called milk blisters or milk blebs, these are raised white dots on the surface of your nipple. This happens when your nipple pore gets blocked, which causes milk to back up behind it. Research shows that even though they’re white and might look like yeast, there’s no connection between nipple blebs and fungus. You may have just one nipple bleb or several, on one or both breasts.

Nipple blebs can be a sign of an oversupply of breast milk (hyperlactation) or inflammation in your breast. You can, and should, continue to breastfeed if you have a milk bleb.

Subacute mastitis

Subacute mastitis (mammary dysbiosis) is an overgrowth of unhealthy bacteria that causes inflammation and chronic pain in your breast. Here’s what you might feel or notice:

• Deep, aching pain in your breast that spreads to your nipple area.
• Breast tenderness.
• Nipple blebs.

Mastitis isn’t just one condition, but rather a spectrum. Subacute mastitis, also called mammary dysbiosis, is on one end of the spectrum. Without proper treatment, it can lead to inflammatory mastitis, followed by bacterial mastitis and ultimately an abscess. Proper management can stop this progression. This is why the correct diagnosis early on is so important.

Nipple vasospasm

Nipple vasospasm can happen to people with Raynaud’s syndrome. It’s when blood vessels around your nipple narrow (constrict) when your skin is exposed to cold temperatures. You may experience:

• Color changes in your nipple to a paler color.
• Pain that feels like it’s radiating deep into your breast.

Factors that may make vasospasm worse include:

• Your baby not latching properly onto your breast.
• Improperly fitting breast pump flanges.
• Oversupply of milk.
• Changes in temperature.

Your symptoms might be worse immediately after breastfeeding or pumping, or when you step out of a hot shower into a room with cooler air.

How are nipple pain, itching and rashes treated?

Treatment depends on the underlying condition. Possible treatments include:

• Topical steroid cream, to treat dermatitis or nipple blebs.
• Antibiotics, to treat subacute mastitis.
• Heat (breast warmers), to treat nipple vasospasm.

Your provider will recommend the best treatment for you based on the cause of your symptoms. In the case of dermatitis, they’ll also help you figure out what’s causing the irritation or allergy so you can avoid contact with it.

Can these symptoms be prevented?

It’s not always possible to prevent pain, itching or other symptoms when you breastfeed. But you can gain advice and resources from a lactation consultant at any point during your breastfeeding journey (or even while you’re still pregnant). They’ll help you with issues like breastfeeding positions and latching. They can also help you figure out the cause of symptoms if they arise.

When should I call my healthcare provider?

Contact a lactation consultant or breastfeeding medicine specialist if you:

• Have pain, itching or rashes affecting any part of your breast.
• Have new or changing symptoms.
• Don’t see improvement from treatment.

Can I get thrush from my baby?

No. If your baby has oral thrush (yeast infection in their mouth), you don’t have to worry. It’s not contagious. If your baby has oral thrush, it might look like white bumps or patches on their gums, tongue, lips or throat that won’t rub off. They may be fussier at feedings because it hurts to suck or swallow. They may also have a diaper rash.

Thrush won’t pass from your baby’s mouth to your nipple. You don’t need to sterilize the parts of your breast pump or your baby’s toys (instead, just follow your normal cleaning routines). Also, you don’t need antifungal treatment at the same time as your baby. These are measures people used to think were necessary. Experts now know you’re not at risk of catching thrush from your baby or passing it back and forth.