1) Reasons for using a steroid preparation
Steroids decrease inflammation and are used in preparations for various skin problems. Steroid preparations can be used by breastfeeding mothers for:
Steroids can be combined with antibiotics and antifungal agents to create combination ointments such as all-purpose nipple ointment [APNO]. We have these useful in treating small, infected, late-onset wounds that do not respond to other treatment.
Steroid preparations are usually prescribed by health-care providers.
2) Steroid strength
There are many types of steroids with different strengths. They have been classified into seven groups, ranging from least potent to ultra-high strength (Ference 2009).
3) Steroid forms
Steroid skin preparations come in various forms:
Ointments are greasy, which increases the absorption of the steroid and generally results in good coverage of an area. Ointments are preferred if the skin is open or weeping as they provide more moisture to the wounds.
Creams are mixtures of oil and water. They are not as strong as ointments and contain preservatives that can sting.
Lotions contain alcohol, which can also sting.
4) The use of steroid preparations by breastfeeding mothers
The choice of steroid preparation depends on:
- The problem being treated.
- The location of the problem.
- How often it needs to be applied.
- How long it needs to be used.
- The risks of side-effects.
a) Strength and form
In general, low to moderate strength steroids are effective as the breast skin is thin and responds well to steroids. Strong preparations should not be used on the breast, areola, or nipple.
We have found that mothers report ointments most soothing and prefer these over lotions and creams.
b) Safety for the baby
Skin preparations used on the nipple and areola can be swallowed by breastfeeding babies. They have many ingredients which will be indicated on the container. Please review these with your health-care providers to ensure they are not toxic to the baby.
To minimize the use of worrisome ingredients such as petrolatum and mineral oil, mothers can use a preparation made by combining modified lanolin and an appropriate steroid powder. This is generally done by a specialist (compounding) pharmacist. This may be more costly than pre-made preparations.