Is Hydrocortisone, Topical Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use Hydrocortisone, Topical? Is Hydrocortisone, Topical safe for nursing mother and child? Does Hydrocortisone, Topical extracts into breast milk? Does Hydrocortisone, Topical has any long term or short term side effects on infants? Can Hydrocortisone, Topical influence milk supply or can Hydrocortisone, Topical decrease milk supply in lactating mothers?

Cortisol is a normal component of breast milk. Although unlikely to achieve harmful levels for the infant, it is preferred the use of an alternative (Methylprednisolone, Prednisolone, Prednisone). Intra-articular administration of depot prednisone derivatives may be a cause of transient decrease of milk production. Eleventh WHO Model List of Essential Drugs 2002: Compatible with breastfeeding.

Topical hydrocortisone has not been studied during breastfeeding. Since only extensive application of the most potent corticosteroids may cause systemic effects in the mother, it is unlikely that short-term application of topical hydrocortisone would pose a risk to the breastfed infant by passage into breastmilk. However, it would be prudent to use the least potent drug on the smallest area of skin possible. It is particularly important to ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.[1] Any topical corticosteroid should be wiped off thoroughly prior to nursing if it is being applied to the breast or nipple area. Maternal use rectally with a cream or by suppository poses very little risk to the breastfed infant.

Topical application of a corticosteroid with relatively high mineralocorticoid activity (isofluprednone acetate) to the mother's nipples resulted in prolonged QT interval, cushingoid appearance, severe hypertension, decreased growth and electrolyte abnormalities in her 2-month-old breastfed infant. The mother had used the cream since birth for painful nipples.[2]