Nipple pain and trauma remain some of the most common reasons new parents stop breastfeeding earlier than planned. For International Board Certified Lactation Consultants (IBCLCs), knowing how to evaluate and manage nipple damage effectively is critical to keeping the breastfeeding relationship on track.

Understanding Moist Wound Healing

Moist wound healing refers to keeping the wound surface slightly hydrated to promote epithelial regeneration, reduce pain, and improve overall healing outcomes. This concept, introduced in the 1960s, is now a standard in dermatological wound care (Nakamura et al., 2024; Nuutila & Eriksson, 2021).

In the context of breastfeeding-related nipple trauma, moist wound healing is typically achieved through:

• Lanolin ointment

• Hydrogel dressings

• Aloe vera gel

• Breast milk (to a lesser extent)

What the Evidence Says

Moisturizing Therapies (Lanolin, Hydrogel, Aloe Vera)

• A 2024 systematic review concluded that moisturizing therapies help reduce pain and trauma more effectively than dry methods, but cautioned that high-moisture interventions like hydrogels may carry a small risk of infection (Nakamura et al., 2024).

• Another review found inconsistent results for lanolin, with one trial showing similar outcomes to breast milk (Martimbianco et al., 2024).

• A recent trial comparing aloe gel to lanolin found aloe was significantly more effective in reducing pain and healing time (Wang et al., 2024).

Bottom line: Moisture promotes healing—but not all moist therapies are equal. Aloe vera appears more effective than lanolin. Hydrogels may help but carry a slight infection risk if not properly managed.

Peppermint Water

Peppermint water, long used as a traditional remedy, is gaining evidence-based support.

• Multiple studies found that peppermint water significantly reduced pain and trauma compared to lanolin and breast milk (Sayyah Melli et al., 2007; Jayan et al., 2021).

• A large quasi-experimental study from Egypt showed that peppermint water users had less nipple trauma and reported lower pain scores by day 14 compared to those using expressed breast milk (Gouda et al., 2017).

Bottom line: Peppermint water appears highly effective at reducing nipple pain and promoting healing, sometimes outperforming traditional moist healing options like lanolin.

Expressed Breast Milk

Still one of the most commonly recommended interventions for nipple soreness, expressed breast milk (EBM) is affordable and accessible.

• However, several studies show that EBM is less effective than other topical agents, especially peppermint water (Gouda et al., 2017; Sayyah Melli et al., 2007).

• Its effects are attributed more to antimicrobial and growth factor properties, but it lacks the sustained moisture barrier offered by creams or gels.

Bottom line: EBM is better than doing nothing and is safe—but not the most effective option available.

Honey

While not used frequently in lactation care, honey has demonstrated broad antimicrobial and regenerative effects in wound care (Tashkandi, 2021). Its viscous nature creates a moist barrier that promotes healing.

Caution: Honey is not safe for infants and should not be used on the nipple if the baby may ingest it.

Moist Wound Healing vs. Other Interventions

Key Takeaways for IBCLCs

• Correcting latch remains the first step—no intervention works if trauma continues.

• Moist wound healing is evidence-supported, but choice of agent matters. Aloe vera and peppermint water show better results than lanolin in current research.

• Educate parents early about positioning, early signs of trauma, and effective, safe topical options to prevent escalation.

References

Brent, N., Rudy, S. J., Redd, B., Rudy, T. E., & Roth, L. A. (1998). Sore nipples in breast-feeding women: A clinical trial of wound dressings vs conventional care. Archives of Pediatrics & Adolescent Medicine, 152(11), 1077–1082.

Douglas, P. (2022). Re-thinking lactation-related nipple pain and damage. Women’s Health, 18. https://doi.org/10.1177/17455057221087865

Gouda, E., Nour, S. A., Gonied, A. S., & Shaban, R. E. (2017). Effect of peppermint water versus expressed breast milk on nipple trauma among lactating primiparous. Zagazig Nursing Journal, 13(1), 227–243.

Hekmatpou, D., Mehrabi, F., Rahzani, K., & Aminiyan, A. (2019). The effect of Aloe Vera clinical trials on prevention and healing of skin wound: A systematic review. Iranian Journal of Medical Sciences, 44(1), 1–9.

Jayan, J. K., John, S., & Siby, R. (2021). Effect of peppermint water vs lanolin ointment application in management of cracked nipple. International Journal of Health Sciences and Research, 11(12), 70–75.

Martimbianco, A. L. C., et al. (2024). Nonpharmacological interventions for treating breastfeeding nipple pain: Systematic review and meta-analysis. Breastfeeding Medicine, 19(8), 599–611. https://doi.org/10.1089/bfm.2024.0043

Nakamura, M., Luo, Y., & Ebina, Y. (2024). Systematic review on the efficacy of moisturizing therapy in treating nipple trauma and nipple pain. Journal of Human Lactation, 41(1), 39–53. https://doi.org/10.1177/08903344241301401

Sayyah Melli, M., et al. (2007). Effect of peppermint water on prevention of nipple cracks in lactating primiparous women: A randomized controlled trial. International Breastfeeding Journal, 2(7). https://doi.org/10.1186/1746-4358-2-7

Tashkandi, H. (2021). Honey in wound healing: An updated review. Open Life Sciences, 16, 1091–1100. https://doi.org/10.1515/biol-2021-0084

Wang, R.-H., et al. (2024). Effects of aloe gel on lactating women with nipple trauma. Breastfeeding Medicine, 19(6), 445–450. https://doi.org/10.1089/bfm.2023.0265