Does anyone have experience using a higher class steroid (lower potency) in APNO instead of Betamethasone, 0.1%. Since ointments take longer to absorb when applied to the skin, and since most prescribers often prefer using the lowest effective dose, especially when dealing with neonates, then if clinically effective, wouldn't Hydrocortisone 2.5% ointment be more appropriate to use instead of betamethasone initially. Although its recommended that APNO be applied sparingly, there is variation in what mom's consider "sparingly," while some moms use a larger amount on the nipple/areolar surface, and after every breastfeeding versus qid (even though instructions say otherwise).  Have there been any studies to address this issue? Any clinical cases?
Many thanks,
Mary Grimanis, PNP, IBCLC
Boston Children's Hospital

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