All purpose nipple ointment is a 3 part mixture of antibiotic, anti-fungal, and steroidal ointment. It is usually prescribed when someone has nipple damage and the basic care measures aren’t working, like checking latch and positioning, using lanolin or other nipple balms, using correct flange size, etc..
APNO is a sort of “throw the kitchen sink at it” solution and is made to treat bacteria, yeast, and inflammation all in one. The issue is that anti-fungal ointments can cause irritation to already irritated, sensitive skin and should be avoided unless absolutely indicated (Haggerty, M.).
Yeast infections are actually very rare on the nipple (Cleveland Clinic). Due to their highly vascular nature, nipples are not prone to yeast. Most commonly, nipples and the areola are affected by dermatitis, causing cracked, dry, irritated skin (Physician Guide to Breastfeeding).
Instead of taking painful skin biopsys from an already damaged sensitive area, providers will prescribe APNO and hope that something in this formulation will work.
The steroid in the APNO actually does help dermatitis, which is the most commonly misdiagnosed as yeast infection, so women might feel some relief when initially using APNO due to that. However, it is usually not due to the antifungal or antibiotic properties.
We would like to avoid using medications that are not needed (like antibiotics) and irritants that can inflame the area more (like anti-fungals). If you’re having nipple symptoms and seeking help from your provider, you might think to try discussing the possibility of dermatitis and treatment with a steroid instead of APNO.
If you’d like to see more in this topic, check out these sites listed below.
Resources
Just say no to apno and Physican Guide to Breastfeeding
Cleveland Clinic (Ed.). (n.d.). Nipple Pain, Itching & Rashes: Could It Be a Nipple Yeast Infection. Cleveland Clinic. https://my.clevelandclinic.org/health/symptoms/22968-nipple-yeast-infection
Haggerty, M. (2021b, May 10). Just say “no” to apno. Integrative Fourth Trimester Care & Lactation in the Home. https://fourthtrimesterdoc.com/blog/just-say-no-to-apno
Physician Guide to Breastfeeding. (2023, August 18). Yeast infection while breastfeeding?. Physician Guide to Breastfeeding. https://physicianguidetobreastfeeding.org/mythbusters/yeast/
