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1. "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
-
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%
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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.
2. Gentian violet
for treating Candida is discussed in
here.
3. Grapefruit Seed
Extract
Grapefruit seed extract can also be used for
treating Candida as well. It can be used
directly on the nipples and/or orally. If
used directly on the nipples, it should be
diluted (5 to 15 drops in 30 ml or 1 ounce
of water), applied on the nipples with a
Q-tip or cotton ball, allowed to dry, and
then covered, sparingly, with the all
purpose nipple ointment. By mouth,
grapefruit seed extract can be taken as a
pill, 250 mg three times a day.
4. Treatments for
Raynaud's Phenomenon (blanching of the
nipple)
Raynaud's phenomenon is due to spasm of
blood vessels preventing blood from getting
to a particular area of the body. It occurs
in response to a drop in temperature. Most
commonly, Raynaud's phenomenon will occur in
the fingers, typically when someone goes
outside from a warm house on a cool day. The
fingers will turn white and the lack of
blood getting to the tips of the fingers
will cause pain. Raynaud's phenomenon occurs
more commonly in women than men, and is
often associated with illnesses such as
rheumatoid arthritis.
Raynaud's phenomenon
can also occur in nipples. In fact, it is
much more common than generally believed. It
can occur along with any cause of sore
nipples, but it may also, on occasion, occur
without any other kind of nipple pain at
all.
Typically, Raynaud's
phenomenon occurs after the feeding is over,
once the baby is already off the breast.
Presumably, the outside air is cooler than
the inside of the baby's mouth. When the
baby comes off the breast, the nipple is its
usual colour, but soon, within minutes or
even seconds, the nipple will start to turn
white. Mothers generally describe a burning
pain when the nipple turns white. After
turning white for a while, the nipple may
actually turn back to its normal colour (as
blood starts to flow back to the nipple),
and the mother will notice a throbbing pain.
The nipple may go back and forth between
colours (and types of pain) for several
minutes or even an hour or two.
The treatment for
Raynaud's phenomenon is to fix the original
cause of the pain (poor latch, Candida etc).
Almost always, as the nipple soreness from
another cause is getting better, so will the
pain from Raynaud's phenomenon get better,
but more slowly. Fixing the original cause
of the pain (improving the latch, treating
Candida etc) should be the focus of
treatment. However, some mothers no longer
have pain during the feeding, or never had
it at all. Indeed, some start having
Raynaud's phenomenon during the pregnancy.
If the pain is mild, there may be no reason
to treat, and reassurance is all that is
necessary. However, in some cases it is
worth treating, especially if severe, and
especially if the pain during the feeding
does not improve, as severe restriction of
blood supply to the nipple may delay
healing.
The first choice for
treatment is:
-
Vitamin B6.
This has shown to work by trial
and error, but it does seem to
work. There is no scientific
evidence that it works, but it
does nevertheless. It is safe
and will do no harm. The dose is
150-200 mg/day once a day for
four days, followed by 25 mg/day
once a day. The mother continues
it until she is pain free for a
few weeks. It can be restarted
if necessary. If the pain
resolves with the larger dose
but returns with the smaller
dose, you can go back to the
higher dose. If you have been
pain free for a week or two, try
going off the vitamin B6. If
vitamin B6 does not work within
a few days, it probably won't.
It is then useful to try:
-
Nifedipine.
This is a drug used for
hypertension. One 30 mg tablet
of the slow release formulation
once a day often takes away the
pain of Raynaud's phenomenon.
After two weeks, stop the
medication. If pain returns
(about 10% of mothers), start it
again. After two weeks, stop the
medication. If pain returns (a
very small number of mothers),
start it again. No mothers I am
aware of took more than three,
two week courses. Side effects
are uncommon, but headache may
occur.
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Nitroglycerin paste. We no
longer recommend it, as severe
headache associated with its use
is fairly common. It also does
not work more than about 50% of
the time.
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5. Fluconazole for
treating Candida is covered in
here.
About The Author:: Dr. Jack Newman is a Toronto
pediatrician who has practiced medicine since 1970. In 1984 he established the
first hospital based breastfeeding clinic in Canada, at the Hospital for Sick
Children in Toronto. He now holds breastfeeding clinics in several Toronto area
hospitals. Jack has been a consultant with UNICEF's Baby Friendly Hospital
Initiative and has spoken at conferences around the world. He is the father of
three children, all breastfed.
Dr. Newman is the author of
"The Ultimate Breastfeeding Book of Answers"
NOTE: The article above titled "Treatments for Sore Nipples & Sore
Breasts -(2)" was written by Dr. Jack Newman and is the opinion of its author. "The New Parents Guide" does not guarantee the information to
be factual. Always use the guidance of your personal
doctor or your child's doctor over information you read on this site or elsewhere; your doctors know what is
best for you and your baby.
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