Jay, I do not recommend that women use the OTC monistat or any of the
vaginal preps for nipple/areolar use. These are made for vaginal mucosa,
not for squamous epithelium, which is what the nipple has. Further,
monistat in particular I have seen a fair amount of contact dermatitis,
both on the breast and vaginally as well. Monistat-derm would be ok, but
again I avoid it because of a high rate of contact dermatitis. I actually
find that nystatin ointment is a good one because it doesn't have to be
wiped off. The PDR says that it can be used for mucocutaneous surfaces as
well, which is what oral mucosa is. (But I don't prescribe the ointment,
just the suspension for the mouth). In general I find that any of the yeast
creams have a tendency to create some irritation of the nipple and areola.
Sometimes adding a steroid ointment helps, and sometimes nothing helps
except diflucan.
        About wiping stuff off the nipple...I don't recommend a moist
cotton ball, as water is drying and can promote cracking. I recommend
mineral oil in tiny amounts with a cotton ball. Some people think lanolin
can promote yeast by keeping the skin so moist...I don't know, but I do
tend to avoid regular use of lanolin when someone has yeast.-Anne Eglash MD