Treatments for Problems
All purpose nipple ointment
This combination of 3 ingredients seems to help for many causes of sore nipples, including poor latch, Candida (yeast), dermatologic conditions, infections of the nipple with bacteria and possibly other causes as well. It is always good, however, to try to assure the best latch possible, because improving the latch helps with any cause of pain.
mupirocin 2% ointment (not cream): 15 grams
betamethasone 0.1% ointment (not cream): 15 grams.
If betamethasone ointment is unavailable, mometasone ointment (15 grams) can be used instead. It is better not to mix creams and ointments.
To which is added miconazole powder so that the final concentration is 2% miconazole. Sometimes it is helpful to add ibuprofen powder as well, so that the final concentration of ibuprofen is 2%.
This combination gives a total volume of approximately 30 grams. Clotrimazole powder to a final concentration of 2% may be substituted if miconazole powder is unavailable, but both exist (the pharmacist may have to order it in). I believe clotrimazole is not as good as miconazole, but I have no proof of that. Using powder gives a better concentration of antifungal agent (miconazole or clotrimazole) and the concentrations of the mupirocin and betamethasone remain higher.
The combination is applied sparingly after each feeding (except the feeding when the mother uses gentian violet). Do not wash or wipe it off, even if the pharmacist asks you to. In Canada, Kenacomb (easier to find) or Viaderm KC (less expensive) ointments (not cream) can be substituted for the above combination, but are distinctly inferior. I used to use nystatin ointment or miconazole cream (15 grams) as part of the mixture, and these work well, but I believe the use of powdered miconazole (or clotrimazole powder) gives better results.
Any pharmacist should be able to make up this ointment, but not all want to. Not all pharmacies carry all the ingredients. If you are having difficulties, ask the pharmacist for the nearest compounding pharmacy.
Handout #3b. Treatments for Sore Nipples and Sore Breasts. January 2005.
Written by Jack Newman, MD, FRCPC © 2005.
This handout may be copied and distributed without further permission, on the condition that it is not used in any context in which the WHO code on the marketing of breastmilk substitutes is violated