Safety in Lactation: Topical corticosteroids

Sarah Fenner, Acting Co-Director, Midlands and East Medicines Advice Service (Midlands site) & UK Drugs in Lactation Advisory ServicePublished

Topical corticosteroids are considered to pose a negligible risk to a breastfeeding infant as long as precautions are taken to avoid direct contact of the breastfeeding infant with treated areas.
For all topical corticosteroids, if application clinically justified, remove from all areas of the breast, especially nipples and areola areas, before breastfeeding with warm water and reapply after feeding. This precaution is to prevent the infant’s mouth coming into direct contact with the topical corticosteroid.
A modified BNF classification has been used to define corticosteroid potency (low/moderate/high/very high). Low or high strength preparations may have a different potency to standard preparations.
Mild or moderate potency corticosteroids are preferred for application to the nipple and areola area. Avoid application of all other (higher potency) corticosteroids to nipple and areola.
When applied to the breast, the use of creams are preferred to ointments due to ease of removal before breastfeeding. Also, where possible, use least potent preparations for shortest duration.