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.
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.
2. Gentian violet
for treating Candida is discussed in handout
#6. See also Candida
Protocol.
3. Grapefruit
seed extract (See Candida
Protocol)
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, occasionally up to 25 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, is, in fact,
probably a result of damage, 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, 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:
