All Purpose Nipple Ointment (APNO)

Nipple pain is a common problem that breastfeeding mothers face. It's not only uncomfortable, but it's also one of the top reasons women decide to stop breastfeeding and wean their babies early. With the right treatment breastfeeding can be more comfortable, allowing women to continue to breastfeed longer and more successfully. One way to combat sore nipples and make breastfeeding more comfortable is to use All Purpose Nipple Ointment (APNO). Here's what you need to know about making, using, and healing your nipples with APNO.

What Is All-Purpose Nipple Ointment? 

All-Purpose Nipple Ointment is the creation of Dr. Jack Newman, a leading breastfeeding researcher and founder of the International Breastfeeding Centre in Canada. APNO is one of the most popular nipple-healing and infection-fighting compounds that breastfeeding mothers use. This triple nipple ointment is made up of three ingredients. They are:

1. An antibiotic: Antibiotics help to heal nipple pain by stopping the growth of bacteria. Preventing the growth of bacteria on the nipples can also help protect against mastitis. 
2. An anti-inflammatory: This type of medication eases nipple pain by reducing any swelling caused by injury, infection, or skin irritation.
3. An anti-fungal: The anti-fungal ingredient in APNO helps to fight off Candida. Candida is the yeast that causes the fungal infection called thrush. 

These three ingredients work together to help soothe the pain and fight off the common organisms that cause sore nipples.

What APNO Is Used to Treat

Breastfeeding moms can get sore nipples for a variety of reasons, and there are different ways to treat them depending on the cause. Dr. Jack Newman's All-Purpose Nipple Ointment treats sore nipples that may arise from:

• a poor latch
• a yeast infection called thrush
• skin conditions of the nipple and areola including psoriasis, eczema, and dermatitis
• bacterial infections
• other causes

How to Make APNO: The Recipe

All Purpose Nipple Ointment is a custom medication that requires a prescription. If, after you speak to your doctor and have an exam, the doctor believes this medication can help, she can provide you with a detailed prescription. Certain pharmacies, known as compounding pharmacies, can prepare this ointment for you. You can also make the mixture yourself, but you still need a prescription. Here's what you need to make APNO.

1. Bactroban (mupirocin) 2% ointment (not cream): 15 grams. Bactroban is the antibiotic. It treats infections of the skin. For this ingredient, you will need to get a prescription from your doctor. If you are not able to get Bactroban, you can use bacitracin. However, bacitracin does not work as well.
2. Betamethasone 0.1% ointment (not cream): 15 grams. Betamethasone is the anti-inflammatory. It treats swelling, itching, dryness, redness, and general irritation of the skin from conditions such as infections, allergic reactions, and eczema. Your doctor can give you a prescription for this medication, or you can get it over-the-counter in a weaker concentration.
3. Miconazole powder to make a final concentration of 2% miconazole. This ingredient is the anti-fungal. It treats yeast and fungal infections of the skin. This medication is available by prescription and over-the-counter. According to Dr. Newman, if miconazole powder is not available, it is better not to substitute anything and just include the two ointments. It is also better to choose an anti-fungal powder over an ointment because it will give you a better concentration of the antifungal agent, and the concentrations of the mupirocin and betamethasone will stay higher.
4. Optional: It may also be helpful to add ibuprofen powder so that the final concentration of ibuprofen is 2%. Ibuprofen is a pain reliever.

Combine all the ingredients in equal parts. Once the mixture is complete, you should have approximately 30 grams or one ounce of APNO.

How to Apply and Use Your APNO

Once you make your All Purpose Nipple Ointment or pick it up from the pharmacy, you are ready to start using it. You can place a tiny amount of your APNO mixture onto your nipples and areola after each breastfeeding session. You do not need to wash this ointment off before the next feeding. However, you should only be using a very small amount, so it will not harm your baby. 

You should begin to see (and feel) results within a few days, but you can continue to use the mixture for two to three weeks if it's needed. But, keep in mind, it is a medication, so you want to use it for the least amount of time as possible. If your condition does not improve in two to three weeks, you should go back to see your doctor, and consult an international board-certified lactation consultant (ICBLC). An IBCLC is specifically trained in the management of breastfeeding issues.

How to Use APNO Along With Gentian Violet

Gentian violet is an over-the-counter product that treats thrush. It is a product that you can find in natural food stores. Some breastfeeding moms use gentian violet along with APNO to treat sore nipples due to Candida albicans (you should only use gentian violet if you have thrush). Here is the recommended way to use this combination treatment.

• Use gentian violet once a day for 3 or 4 days. Take a cotton swab and dip it into a 0.5 to 1% solution of gentian violet (do not use a solution greater than 1%). Spread a small amount of the gentian violet around the nipple and areola on one side and let it dry. It should only take a couple of seconds. Then, breastfeed on that side. Do the same thing on the other side. There is no need to reapply after nursing if the baby feeds from both breasts and both are purple. Remember, you only need a drop, and it's only once a day. About 10 milliliters total of gentian violet is more than enough for an entire treatment.
• Use APNO for all other feedings. Do not use APNO for the feeding that you apply gentian violet. Apply APNO after every other feeding during the day. 

Using gentian violet may be messy, and it will turn your breasts and your baby's mouth purple. But, when it's used with APNO, it can help to relieve nipple pain and heal thrush in just a few days. If you don't feel better in a week, stop using gentian violet and see your doctor and lactation consultant.

A Word From Verywell

Breastfeeding shouldn't hurt. There may be a little tenderness when your baby first latches on, especially during the first few weeks. But, you should not be in pain for the entire feeding, and the mild latching pain should get better as the days and weeks go on.

If your nipples become so sore that you begin to dread breastfeeding, then something is not right. Once breastfeeding becomes painful, you should get help right away. Don't wait to find out what's going on and begin treatment. The sooner you can feel more comfortable and get back to breastfeeding, the better it will be for you and your baby. 

Edited by Donna Murray