Prevention and management of nipple wound: a systematic review

Abstract Background Nipple wounds are common complications during breastfeeding and may lead to pain, early cessation of breastfeeding, and maternal distress. Various pharmacological and non-pharmacological approaches have been proposed for the prevention and treatment of nipple wounds; however, evidence regarding their effectiveness remains inconsistent. This systematic review aimed to comprehensively evaluate current evidence on methods used for both the prevention and management of nipple wounds. Methods This systematic review was conducted in accordance with the PRISMA 2020 guidelines. Literature searches were performed between March and April 2024 using the databases PubMed, Cochrane Library, Web of Science, and Scopus. To ensure that the review reflects the most up-to-date evidence, the search was repeated in January 2026 using the same databases and search strategy. No additional studies meeting the inclusion criteria were identified. Only studies published in English were included, and grey literature was not considered. MeSH terms and keywords including “wound,” “nipple wound,” “nipple trauma,” “nipple fissure,” “prevention of nipple wound,” and “treatment of nipple wound” were used in various combinations. Randomized controlled trials (RCTs) published within the last nine years were included. Study selection followed the PICOS framework. The methodological quality of the included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists appropriate to each study design. Results Fifteen randomized controlled trials involving a total of 1,796 participants were included. The findings indicated that non-pharmacological interventions—such as proper breastfeeding techniques, nipple care education, breast milk application, and supportive devices—were effective in both preventing the development of nipple wounds and reducing the severity, pain, and healing duration of existing wounds. Compared with pharmacological treatments, non-pharmacological approaches demonstrated comparable or superior outcomes in several studies. Conclusıon The evidence suggests that non-pharmacological methods play a beneficial role in the prevention and treatment of nipple wounds. However, the effectiveness of these interventions should be interpreted with caution due to heterogeneity in intervention types, outcome measures, and variability in the methodological quality of the included studies. These interventions appear to be safe, accessible, and effective, particularly when integrated with breastfeeding education and support. Further high-quality randomized controlled trials (RCTs) with standardized outcome measures are needed to strengthen the evidence base and inform clinical practice.