Denise
I have concerns about potential long term corticiosteriod use on
nipples, although most medicos are not concerned about minimal or
short-term use.

Corticosteroid excess, with hypertension and profound suppression of
pituitary-adrenal function, has been reported in an infant whose
mother used a corticosteroid on her nipples for two months. Ref:  De
Stefano P et al (1983) Factitious hypertension with mineralocorticoid
excess in an infant. Helv Paediatr Acta 38:185-89

Dr Albert Kligman of the Foundation for Basic Cutaneous Research in
Philadelphia has studied steroid sparing on children with atopic
dermatitis.  One arm got Psorcon Cream (a steriod) twice daily and
the other arm got Psorcon once daily and Lansinoh once daily. After
two weeks, the results on both arms were the same, with the
dermatitis nearly cleared.

On the basis of this, I suggest to breastfeeding mothers with nipple
excema that they discuss steroid sparing with their dermatologist.
This means using Lansinoh after every feed to keep the skin supple
and protect it from surface wetness, and a steroid ointment once a
day at a time when the baby is most likely to have the longest break
from breastfeeding.

If the woman is pregnant, I recommend that she pay particular attention
to getting the nipple skin in optimal condition before delivery.
Nipple skin responds to oestogen levels, and some women develop quite
deep furrows in their nipples as a result of the hormonal changes
during pregnancy - this seems to be exacerbated if the mother has
rather dry skin or eczema. These furrows have a tendency to crack
open as the oestrogen levels drop and the baby commences
breastfeeding.  While most women don't need antenatal nipple
preparation, women with skin problems appear to benefit greatly.

I have seen good results with this protocol.  It doesn't cure, but it
seems to enable breastfeeding for women with skin problems.

Ros Escott
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