THE “ALL-PURPOSE NIPPLE OINTMENT” OR APNO
We call our nipple ointment “all purpose” since it contains ingredients that help deal with multiple causes or aggravating factors of sore nipples. Breastfeeding parents with sore nipples don’t have time to try out different treatments that may or may not work, so we have combined various treatments in one ointment. Of course, preventing sore nipples in the first place is the best treatment and adjusting how the baby takes the breast can do more than anything to decrease and eliminate the breastfeeding parent’s nipple soreness. Please note that the “all-purpose nipple ointment” is a stop gap measure only and that the definitive treatment of sore nipples is to help the baby latch on as well as possible.
See these other information sheets: Sore Nipples, Latching and Feeding Management.
THE APNO CONTAINS:
Note that nystatin ointment, which we used to use and which decreases the concentration of the other ingredients, is far inferior to miconazole and also tastes bad.
I write the prescription this way.
1. Mupirocin ointment 2%: 15 grams
2. Betamethasone ointment 0.1%: 15 grams
3. To which is added miconazole powder to a concentration of 2% miconazole
Total: about 30 grams combinedApply sparingly after each feeding. Do not wash or wipe off.
If possible, it is best to get the prescription filled at a compounding pharmacy. You can find a list of compounding pharmacies by going to http://www.pccarx.com/. Click “Find a compounder” at the top, then add relevant information.
HOW TO USE THE OINTMENT:
1. Apply sparingly after each feeding. “Sparingly” means that the quantity of the ointment used is just enough to make the nipples and areola glossy or shiny.
2. Do not wash it off or wipe it off, even if the baby comes back to the breast earlier than expected.
HOW LONG SHOULD THE OINTMENT BE USED?
Any drug should be used for the shortest period of time necessary and the same is true for our ointment. If the breastfeeding parent still needs the ointment after two or three weeks, or the pain returns after the breastfeeding parent has stopped the ointment, the parent should get “hands on” help again to find out why the ointment is still necessary. The most important step for decreasing nipple pain is still getting the “best latch possible.” Sometimes a tongue tie has not been noticed and is a reason for continued pain.
Some pharmacists have told breastfeeding parents that the steroid in the ointment will cause thinning of the skin if used for too long. While this is a concern with any steroid applied to the skin, we have not seen this happen even when breastfeeding parents have used it for months.
Updated February 2017
The information presented here is general and not a substitute for personalized treatment from an International Board Certified Lactation Consultant (IBCLC) or other qualified medical professionals.
This information sheet may be copied and distributed without further permission on the condition that it is not used in any context that violates the WHO International Code on the Marketing of Breastmilk Substitutes (1981) and subsequent World Health Assembly resolutions. If you don’t know what this means, please email us to ask!
Questions or concerns? Email Dr. Jack Newman (read the page carefully, and answer the listed questions).
Make an appointment at the Newman Breastfeeding Clinic.