Milk Bleb

What is a milk bleb?

A milk bleb is a small dot (white, clear or yellow) that can form on the surface of your nipple. You may have one dot on just one nipple or multiple dots on one or both nipples. You might hear your healthcare provider refer to these dots as nipple blebs or simply, blebs. Some people call them milk blisters.

Milk blebs occur in people who are breastfeeding. They’re not dangerous or cancerous, and they’re not a sign of a fungal infection. Blebs are a sign of inflammation in your milk ducts. Your milk ducts are small tubes in your breasts that carry milk to your nipples.

Nipple blebs can be very painful and make it hard for you to breastfeed. You might feel sharp or shooting pain while breastfeeding and afterward. The pain might spread deeper into your breast. Blebs can also block the tiny openings on your nipples (nipple pores) that allow milk to come out.

If you notice one or more blebs on your nipples, contact a healthcare provider. A breastfeeding medicine specialist (a medical doctor with advanced training in breastfeeding management) or lactation consultant can help.

They’ll take a look at the spots and check for associated conditions. Some people with milk blebs also have hyperlactation (oversupply of milk) or mastitis. Your provider will recommend treatment to clear up the blebs and treat other conditions so you can feel better and breastfeed comfortably.

Milk bleb vs. thrush

Milk blebs are common among people who breastfeed. On the other hand, it’s highly unlikely you’ll experience thrush on your nipples (a nipple yeast infection) while nursing.

Milk blebs can appear as white dots on your nipples. For many years, people believed white spots on nipples could indicate a nipple yeast infection. However, the latest research shows fungus typically doesn’t grow on nipples. And there’s no scientific evidence that nipple yeast infections can occur while nursing. Instead, other issues (like blebs and dermatitis) cause pain and difficulty breastfeeding.

That’s why antifungal medications won’t help your symptoms and shouldn’t be used on your nipples. There’s no fungus there to treat. Using such medications may irritate your nipples and make your symptoms worse.

What causes nipple blebs?

Blebs show up on the surface of your nipple, so you might think your nipple is the problem. But, in fact, blebs are a sign that something else is going on below your skin’s surface. Specifically, the lining of your milk ducts is inflamed, and as it sloughs off, it collects at the surface of your nipple.

What causes ductal inflammation isn’t always obvious. Researchers believe hyperlactation (oversupply of milk) may be one cause. An imbalance between how much milk your breasts make and how much is removed might also play a role. Bacterial overgrowth (dysbiosis) can also cause nipple blebs.

Does a poor latch cause nipple blebs?

The short answer based on the latest research is: Probably not.

There’s been some debate on this point among healthcare providers. Some believe a poor latch can traumatize your nipples, leading to blebs. But other research shows that blebs appear in people with no history of nipple trauma.

The most recent research supports the idea that ductal inflammation is the main cause of blebs that form on the surface of your nipples. If your baby has a poor latch, and you also have blebs, you might think the two are related. But other factors are likely affecting your baby’s latch and also causing blebs.

For example, if you have an oversupply of milk, the flow of milk into your baby’s mouth might be too forceful. This can cause your baby to pull away from your breast instead of staying latched on. This oversupply also causes inflamed milk ducts, which in turn lead to nipple blebs. So, both the poor latch and the blebs are signs of the same underlying problem (hyperlactation).

What does milk bleb treatment involve?

Healthcare providers treat nipple blebs by:

• Prescribing a topical steroid cream. Your provider may prescribe triamcinolone, which can reduce inflammation on the surface of your nipple. Your provider will tell you how often to apply this cream to your nipple. Over-the-counter creams like hydrocortisone typically aren’t strong enough to help with blebs.
• Recommending you take sunflower lecithin. This is an oral supplement (you take it by mouth). It can ease inflammation in your milk ducts.
• Treating associated conditions. Your provider will identify any other conditions that are contributing to inflammation in your milk ducts. They’ll tailor treatment to your needs. For example, if you have bacterial or subacute mastitis, they’ll prescribe antibiotics. If you have an oversupply of milk, your provider may recommend block feeding. This means you breastfeed or express milk from one breast for a certain amount of time before switching to the other breast. You should only do block feeding under the close supervision of a healthcare provider.

In many cases, treatment clears up in weeks, but some blebs can take one or two months to completely resolve.

What can I do at home to get rid of a milk bleb?

The most important thing to know about managing blebs is that you shouldn’t pick at them, poke them with a needle or otherwise try to slough them off. Doing so might make you feel better briefly, but the relief won’t last. Trying to pop or unroof a bleb will traumatize your nipples and make your symptoms worse. The popped milk blister will look red and form a scab. Constant unroofing can lead to bleeding and scarring.

Plus, as popping a milk bleb won’t address the root cause, the blebs will keep coming back.

You also shouldn’t use Gentian violet (an antifungal) or other harsh substances on your nipples. These cause trauma and scarring and only make matters worse. Using antifungal medication isn’t appropriate for nipple blebs, as there’s no fungal infection involved.

Instead of these methods, follow your provider’s guidance on at-home care. They may recommend you use the BAIT approach. This involves:

• B: Breast rest.
• A: Advil®.
• I: Ice.
• T: Tylenol®.

The idea here is to avoid removing too much milk from your breast in the setting of inflammation or oversupply. Don’t overfeed or over-pump. Breastfeed as normal, but give your baby the less full breast first. This can help slow down milk production if you have oversupply. Ice and over-the-counter medications ease pain and inflammation.

When should blebs be treated by a healthcare provider?

You should always consult a healthcare provider if you notice a nipple bleb. Don’t use a needle to poke it or try to unroof it yourself. Your provider will determine the best treatment for the bleb, as well as the underlying cause.

What if a milk bleb won’t go away?

If your milk bleb isn’t responding to treatment, your healthcare provider will decide the best next steps.

Nipple blebs don’t affect everyone in the same way. You might have one bleb that quickly goes away with treatment and that’s the end of it. Or you might have multiple blebs that clear up, but soon new ones form. Researchers continue to explore how and why blebs form and how best to treat them.