Can Breastfeeding Be Causing Your Rash?
Breastfeeding itself does not directly cause rashes in the breastfeeding mother, but nipple eczema is a recognized condition that can develop during lactation due to irritation, friction, and moisture exposure from nursing. 1
Understanding the Differential Diagnosis
The most common pathologic cause of rash during breastfeeding is atopic eruption of pregnancy (AEP), which presents with an eczematous rash on the face, neck, trunk, and extremities—not specifically the nipple area. 2 If your rash is localized to the nipple and areola, this suggests nipple eczema rather than a systemic condition. 1
Key Distinguishing Features to Assess:
- Location: Nipple eczema affects the nipple and areola specifically, while generalized eczema appears on other body areas 1
- Presence of pruritus: Intense itching, especially on palms and soles without a rash, suggests intrahepatic cholestasis of pregnancy (though this typically occurs during pregnancy, not postpartum) 2
- Associated rash characteristics: Excoriations from scratching versus primary lesions help differentiate conditions 2
Treatment Approach for Nipple Eczema During Breastfeeding
First-line treatment consists of topical corticosteroids or calcineurin inhibitors, both of which are considered safe during lactation. 1
Specific Management Steps:
Apply emollients regularly after each breastfeeding session to provide a protective lipid film that prevents water loss from the epidermis 3
Use the least potent topical corticosteroid required to control the eczema, stopping for short periods when possible to minimize side effects 3
Avoid irritants: Switch to emollient wash products instead of soaps, as soaps remove natural protective lipids from the skin 3
Address mechanical factors: Adjusting latch/suck positioning during breastfeeding may reduce repetitive friction that perpetuates the condition 1
Consider warm water or black tea compresses for symptomatic relief 1
Important Considerations About Maternal Diet
The evidence regarding maternal dietary elimination during lactation is conflicting and should not be routinely recommended unless there is strong suspicion of food allergy in the infant. 2, 3
- One older study showed that maternal avoidance of common allergens (milk, eggs, fish, peanuts, soybeans) during lactation reduced eczema in high-risk infants from 48% to 22% 4
- However, more recent guidelines note that evidence for maternal allergen avoidance during lactation in protecting against atopy remains conflicting 2, 3
- Maternal dietary restriction should only be considered if the infant (not the mother) shows signs of food allergy, such as eczema, gastrointestinal symptoms, or failure to thrive 5
Common Pitfalls to Avoid
Do not discontinue breastfeeding prematurely based on concerns about causing or worsening eczema. 5 The relationship between breastfeeding and eczema is complex, with some studies showing reverse causation—meaning infants who develop eczema are breastfed longer because parents seek to manage the condition, not that breastfeeding causes it. 6
Do not implement unnecessarily restrictive maternal diets beyond what is medically indicated, as this may compromise maternal nutrition and breastfeeding ability. 5
When to Seek Further Evaluation
If the rash persists despite appropriate topical treatment for 2 weeks, or if diagnostic uncertainty exists (to rule out nipple psoriasis, candidiasis, or Paget's disease), obtain swabs or consider biopsy. 1 Referral to dermatology is warranted for treatment-refractory cases. 2