I apologize if this has been covered before, but I searched the archives and
could not find much (maybe using the wrong search terms).  The post earlier
today describing a mom improving on a mix of clotrimazole, dexamethasone,
and neomycin piqued my curiosity.

I seem to hear of "triple nipple cream" or APNO being used for a variety of
causes of sore nipples, and understand that Dr. Newman advises using a
steroid to reduce pain from inflammation.  I wonder if there are any trials
that support an overall benefit of adding a topical steroid when there is an
obvious infection or open wound -- this seems counterintuitive to wound
healing and fighting infection.  Or are the amounts of steroids used of such
low potency that they do not interfere with the healing process?  A
dermatologist I saw once was *horrified* that I was using a
betamethasone/clotrimazole mix that my ob had prescribed for a raging yeast
infection and fissure.  She ended up being completely
breastfeeding-UNfriendly anyway, but her clinical reasoning on that seemed
logical to me -- she thought I was certainly inhibiting the wound from
healing and likely thinning the skin as well.

In other clinical settings, I can't imagine steroid creams being used on
wounds or in the presence of infection.  I worked with a great pediatrician
during school who frequently lamented how parents often tried to treat
undiagnosed ringworm with hydrocortisone.  This would temporarily relieve
the itchiness, but then she found that these patients required longer
treatment with anti-fungal medications, even if they no longer were using
hydrocortisone.

Do steroids really add anything to treatment of sore nipples, whether or not
a bacterial or fungal infection is suspected or confirmed?  Do they even
really reduce pain?

Thanks for any insight you can offer -- this has got me confused!
Sarah Reece-Stremtan M.D.

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