In my experience, there is often yeast growing in/on the plaque, aggravating 
the problem.  So I often do 5 days of once a day Gentian violet, followed by 
nipple ointment (steroid plus miconazole plus bactroban), and sometimes 
these moms need to keep using 1% hydrocortisone ointment at least once a day 
to keep it at bay once healed.

If it gets better after GV, but then starts to get worse again on the 
ointment, I have used 0.1% triamcinolone ointment (be sure ointment and not 
cream) which is a mid-potency steroid similar to westcort.

Kathy Leeper, MD, IBCLC
MilkWorks- Lincoln, NE

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