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Table of Contents
Vol. 24, No. 1, 2011
Issue release date: December 2010
Section title: Original Paper
Open Access Gateway
Skin Pharmacol Physiol 2011;24:27–35
(DOI:10.1159/000318228)

Positive Effect of HPA Lanolin versus Expressed Breastmilk on Painful and Damaged Nipples during Lactation

Abou-Dakn M.a · Fluhr J.W.b, c · Gensch M.a · Wöckel A.d
aDepartment of Obstetrics and Gynaecology, St. Joseph Hospital, Academic Hospital of the Charité, University Medicine Berlin, bBioskin and cDepartment of Dermatology, Charité University Clinic, Berlin, and dDepartment of Obstetrics and Gynaecology, University Hospital Ulm, Ulm, Germany
email Corresponding Author

Abstract

Painful and/or damaged nipples associated with breastfeeding are common and represent a challenge for both the persons experiencing nipple pain and/or trauma and for those providing treatment. However, evidence-based data has been insufficient to demonstrably minimize these common reasons for failure to initiate or continue successful breastfeeding. The aim of this study was to evaluate the efficacy of specific-grade highly purified anhydrous (HPA) lanolin versus expressed breastmilk (EBM) for the treatment of painful and damaged nipples associated with breastfeeding in a prospective controlled clinical trial evaluating 84 lactating mothers. Nipple trauma and healing rates were rated by the Nipple Trauma Score. Nipple pain intensity was assessed on a visual analog scale. Outcome parameters were in favor of the HPA lanolin group, reaching statistical significance for healing rates, nipple trauma and nipple pain. In our study, we found HPA lanolin more effective than EBM, inducing faster healing of nipple trauma (absolute risk reduction of 0.43) and reducing nipple pain (absolute risk reduction of 0.61 on day 3). We concluded that HPA lanolin, combined with breastfeeding education, was more effective than EBM, combined with breastfeeding education, in reducing nipple pain and promoting healing of nipple trauma.

© 2010 S. Karger AG, Basel


  

Key Words

  • Breastfeeding
  • Breastmilk
  • Highly purified anhydrous lanolin
  • Lactation
  • Nipple pain
  • Nipple trauma
  • Topical treatment

References

  1. Akkuzu G, Taskin L: Impacts of breast-care techniques on prevention of possible postpartum nipple problems. Prof Care Mother Child 2000;10:38–41.
  2. Gartner LM, Morton J, Lawrence RA, Naylor AJ, O’Hare D, Schanler RJ, Eidelman AI: Breastfeeding and the use of human milk. Pediatrics 2005;115:496–506.
  3. Lavergne NA: Does application of tea bags to sore nipples while breastfeeding provide effective relief? J Obstet Gynecol Neonatal Nurs 1997;26:53–58.
  4. Tait P: Nipple pain in breastfeeding women: causes, treatment, and prevention strategies. J Midwifery Womens Health 2000;45:212–215.
  5. Eryilmaz R, Sahin M, Hakan Tekelioglu M, Daldal E: Management of lactational breast abscesses. Breast 2005;14:375–379.
  6. Herd B, Feeney JG: Two aerosol sprays in nipple trauma. Practitioner 1986;230:31–38.
  7. Lochner JE, Livingston CJ, Judkins DZ: Clinical inquiries: which interventions are best for alleviating nipple pain in nursing mothers? J Fam Pract 2009;58:612a–612c.

    External Resources

  8. Pugh LC, Buchko BL, Bishop BA, Cochran JF, Smith LR, Lerew DJ: A comparison of topical agents to relieve nipple pain and enhance breastfeeding. Birth 1996;23:88–93.
  9. Amir LH, Lumley J, Garland SM: A failed RCT to determine if antibiotics prevent mastitis: cracked nipples colonized with Staphylococcus aureus – a randomized treatment trial (ISRCTN65289389). BMC Pregnancy Childbirth 2004;4:19.
  10. Livingstone V, Stringer LJ: The treatment of Staphyloccocus aureus infected sore nipples: a randomized comparative study. J Hum Lact 1999;15:241–246.
  11. Melli MS, Rashidi MR, Nokhoodchi A, Tagavi S, Farzadi L, Sadaghat K, Tahmasebi Z, Sheshvan MK: A randomized trial of peppermint gel, lanolin ointment, and placebo gel to prevent nipple crack in primiparous breastfeeding women. Med Sci Monit 2007;13:CR406–CR411.
  12. Morland-Schultz K, Hill PD: Prevention of and therapies for nipple pain: a systematic review. J Obstet Gynecol Neonatal Nurs 2005;34:428–437.
  13. Sayyah Melli M, Rashidi MR, Delazar A, Madarek E, Kargar Maher MH, Ghasemzadeh A, Sadaghat K, Tahmasebi Z: Effect of peppermint water on prevention of nipple cracks in lactating primiparous women: a randomized controlled trial. Int Breastfeed J 2007;2:7.
  14. Hoppe U (ed): The Lanolin Book. Hamburg, Beiersdorf, 1999.
  15. Elias PM, Man M-Q, Thornfeldt CR, Feingold KR: The epidermal permeability barrier: effects of physiologic and non-physiologic lipids; in Hoppe U (ed): The Lanolin Book. Hamburg, Beiersdorf, 1999, vol 3, pp 253–278.
  16. Rissmann R, Oudshoorn MH, Kocks E, Hennink WE, Ponec M, Bouwstra JA: Lanolin-derived lipid mixtures mimic closely the lipid composition and organization of vernix caseosa lipids. Biochim Biophys Acta 2008;1778:2350–2360.
  17. Clark EW, Blondeel A, Cronin E, Oleffe JA, Wilkinson DS: Lanolin of reduced sensitizing potential. Contact Dermatitis 1981;7:80–83.
  18. Basketter D, Darlenski R, Fluhr JW: Skin irritation and sensitization: mechanisms and new approaches for risk assessment. Skin Pharmacol Physiol 2008;21:191–202.
  19. Fluhr JW, Darlenski R, Angelova-Fischer I, Tsankov N, Basketter D: Skin irritation and sensitization: mechanisms and new approaches for risk assessment. 1. Skin irritation. Skin Pharmacol Physiol 2008;21:124–135.
  20. Duffy EP, Percival P, Kershaw E: Positive effects of an antenatal group teaching session on postnatal nipple pain, nipple trauma and breast feeding rates. Midwifery 1997;13:189–196.
  21. Buchko BL, Pugh LC, Bishop BA, Cochran JF, Smith LR, Lerew DJ: Comfort measures in breastfeeding, primiparous women. J Obstet Gynecol Neonatal Nurs 1994;23:46–52.
  22. Sherman SA, Eisen S, Burwinkle TM, Varni JW: The PedsQL present functioning visual analogue scales: preliminary reliability and validity. Health Qual Life Outcomes 2006;4:75.
  23. Levenstein S, Prantera C, Varvo V, Scribano ML, Berto E, Luzi C, Andreoli A: Development of the Perceived Stress Questionnaire: a new tool for psychosomatic research. J Psychosom Res 1993;37:19–32.
  24. Fliege H, Rose M, Arck P, Walter OB, Kocalevent RD, Weber C, Klapp BF: The Perceived Stress Questionnaire (PSQ) reconsidered: validation and reference values from different clinical and healthy adult samples. Psychosom Med 2005;67:78–88.
  25. Wockel A, Schumann M, Abou-Dakn M: Development of a wound score for the evaluation of cracked nipples during lactation. Arch Gyn Obst 2004;17(suppl 1):270.
  26. Herr K, Spratt KF, Garand L, Li L: Evaluation of the Iowa Pain Thermometer and other selected pain intensity scales in younger and older adult cohorts using controlled clinical pain: a preliminary study. Pain Med 2007;8:585–600.
  27. Armitage P: Theory and practice in medical statistics. Stat Med 2001;20:2537–2548.
  28. Groer M, Davis M, Casey K, Short B, Smith K, Groer S: Neuroendocrine and immune relationships in postpartum fatigue. MCN Am J Matern Child Nurs 2005;30:133–138.
  29. Groer MW, Davis MW: Cytokines, infections, stress, and dysphoric moods in breastfeeders and formula feeders. J Obstet Gynecol Neonatal Nurs 2006;35:599–607.
  30. Daeschlein G, Assadian O, Bruck JC, Meinl C, Kramer A, Koch S: Feasibility and clinical applicability of polihexanide for treatment of second-degree burn wounds. Skin Pharmacol Physiol 2007;20:292–296.
  31. Hughes-Formella B, Wunderlich O, Williams R: Anti-inflammatory and skin-hydrating properties of a dietary supplement and topical formulations containing oligomeric proanthocyanidins. Skin Pharmacol Physiol 2007;20:43–49.
  32. Wockel A, Abou-Dakn M, Beggel A, Arck P: Inflammatory breast diseases during lactation: health effects on the newborn – a literature review. Mediators Inflamm 2008;2008:298760.
  33. Amir LH, Dennerstein L, Garland SM, Fisher J, Farish SJ: Psychological aspects of nipple pain in lactating women. J Psychosom Obstet Gynaecol 1996;17:53–58.
  34. Abou-Dakn M, Richardt A, Schaefer-Graf U, Wöckel A: Inflammatory breast diseases during lactation: milk stasis, puerperal mastitis, abscesses of the breast, and malignant tumors – current and evidence-based strategies for diagnosis and therapy. Breast Care 2010;5:33–37.

    External Resources

  35. Foxman B, D’Arcy H, Gillespie B, Bobo JK, Schwartz K: Lactation mastitis: Occurrence and medical management among 946 breastfeeding women in the United States. Am J Epidemiol 2002;155:103–114.
  36. Centuori S, Burmaz T, Ronfani L, Fragiacomo M, Quintero S, Pavan C, Davanzo R, Cattaneo A: Nipple care, sore nipples, and breastfeeding: a randomized trial. J Hum Lact 1999;15:125–130.
  37. Waldenstrom U, Aarts C: Duration of breastfeeding and breastfeeding problems in relation to length of postpartum stay: a longitudinal cohort study of a national Swedish sample. Acta Paediatr 2004;93:669–676.
  38. Dodd V, Chalmers C: Comparing the use of hydrogel dressings to lanolin ointment with lactating mothers. J Obstet Gynecol Neonatal Nurs 2003;32:486–494.
  39. Wockel A, Beggel A, Gensch M, Abou-Dakn M: Psychological stress and puerperal mastitis: possible pathophysical mechanisms. Curr Womens Health Rev 2007;3:123–127.

  

Author Contacts

Joachim W. Fluhr, MD
Bioskin
Bergmannstrasse 5
DE–10961 Berlin (Germany)
Tel. +49 30 2804 3950, E-Mail joachim.fluhr@gmx.net

  

Article Information

Received: March 19, 2010
Accepted after revision: June 28, 2010
Published online: August 18, 2010
Number of Print Pages : 9
Number of Figures : 5, Number of Tables : 2, Number of References : 39

  

Publication Details

Skin Pharmacology and Physiology (Journal of Pharmacological and Biophysical Research)

Vol. 24, No. 1, Year 2011 (Cover Date: December 2010)

Journal Editor: Lademann J. (Berlin)
ISSN: 1660-5527 (Print), eISSN: 1660-5535 (Online)

For additional information: http://www.karger.com/SPP


Open Access License / Drug Dosage / Disclaimer

Open Access License: This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

Painful and/or damaged nipples associated with breastfeeding are common and represent a challenge for both the persons experiencing nipple pain and/or trauma and for those providing treatment. However, evidence-based data has been insufficient to demonstrably minimize these common reasons for failure to initiate or continue successful breastfeeding. The aim of this study was to evaluate the efficacy of specific-grade highly purified anhydrous (HPA) lanolin versus expressed breastmilk (EBM) for the treatment of painful and damaged nipples associated with breastfeeding in a prospective controlled clinical trial evaluating 84 lactating mothers. Nipple trauma and healing rates were rated by the Nipple Trauma Score. Nipple pain intensity was assessed on a visual analog scale. Outcome parameters were in favor of the HPA lanolin group, reaching statistical significance for healing rates, nipple trauma and nipple pain. In our study, we found HPA lanolin more effective than EBM, inducing faster healing of nipple trauma (absolute risk reduction of 0.43) and reducing nipple pain (absolute risk reduction of 0.61 on day 3). We concluded that HPA lanolin, combined with breastfeeding education, was more effective than EBM, combined with breastfeeding education, in reducing nipple pain and promoting healing of nipple trauma.

© 2010 S. Karger AG, Basel


  

Author Contacts

Joachim W. Fluhr, MD
Bioskin
Bergmannstrasse 5
DE–10961 Berlin (Germany)
Tel. +49 30 2804 3950, E-Mail joachim.fluhr@gmx.net

  

Article Information

Received: March 19, 2010
Accepted after revision: June 28, 2010
Published online: August 18, 2010
Number of Print Pages : 9
Number of Figures : 5, Number of Tables : 2, Number of References : 39

  

Publication Details

Skin Pharmacology and Physiology (Journal of Pharmacological and Biophysical Research)

Vol. 24, No. 1, Year 2011 (Cover Date: December 2010)

Journal Editor: Lademann J. (Berlin)
ISSN: 1660-5527 (Print), eISSN: 1660-5535 (Online)

For additional information: http://www.karger.com/SPP


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 3/19/2010
Accepted: 6/28/2010
Published online: 8/18/2010
Issue release date: December 2010

Number of Print Pages: 9
Number of Figures: 5
Number of Tables: 2

ISSN: 1660-5527 (Print)
eISSN: 1660-5535 (Online)

For additional information: http://www.karger.com/SPP


Open Access License / Drug Dosage

Open Access License: This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Akkuzu G, Taskin L: Impacts of breast-care techniques on prevention of possible postpartum nipple problems. Prof Care Mother Child 2000;10:38–41.
  2. Gartner LM, Morton J, Lawrence RA, Naylor AJ, O’Hare D, Schanler RJ, Eidelman AI: Breastfeeding and the use of human milk. Pediatrics 2005;115:496–506.
  3. Lavergne NA: Does application of tea bags to sore nipples while breastfeeding provide effective relief? J Obstet Gynecol Neonatal Nurs 1997;26:53–58.
  4. Tait P: Nipple pain in breastfeeding women: causes, treatment, and prevention strategies. J Midwifery Womens Health 2000;45:212–215.
  5. Eryilmaz R, Sahin M, Hakan Tekelioglu M, Daldal E: Management of lactational breast abscesses. Breast 2005;14:375–379.
  6. Herd B, Feeney JG: Two aerosol sprays in nipple trauma. Practitioner 1986;230:31–38.
  7. Lochner JE, Livingston CJ, Judkins DZ: Clinical inquiries: which interventions are best for alleviating nipple pain in nursing mothers? J Fam Pract 2009;58:612a–612c.

    External Resources

  8. Pugh LC, Buchko BL, Bishop BA, Cochran JF, Smith LR, Lerew DJ: A comparison of topical agents to relieve nipple pain and enhance breastfeeding. Birth 1996;23:88–93.
  9. Amir LH, Lumley J, Garland SM: A failed RCT to determine if antibiotics prevent mastitis: cracked nipples colonized with Staphylococcus aureus – a randomized treatment trial (ISRCTN65289389). BMC Pregnancy Childbirth 2004;4:19.
  10. Livingstone V, Stringer LJ: The treatment of Staphyloccocus aureus infected sore nipples: a randomized comparative study. J Hum Lact 1999;15:241–246.
  11. Melli MS, Rashidi MR, Nokhoodchi A, Tagavi S, Farzadi L, Sadaghat K, Tahmasebi Z, Sheshvan MK: A randomized trial of peppermint gel, lanolin ointment, and placebo gel to prevent nipple crack in primiparous breastfeeding women. Med Sci Monit 2007;13:CR406–CR411.
  12. Morland-Schultz K, Hill PD: Prevention of and therapies for nipple pain: a systematic review. J Obstet Gynecol Neonatal Nurs 2005;34:428–437.
  13. Sayyah Melli M, Rashidi MR, Delazar A, Madarek E, Kargar Maher MH, Ghasemzadeh A, Sadaghat K, Tahmasebi Z: Effect of peppermint water on prevention of nipple cracks in lactating primiparous women: a randomized controlled trial. Int Breastfeed J 2007;2:7.
  14. Hoppe U (ed): The Lanolin Book. Hamburg, Beiersdorf, 1999.
  15. Elias PM, Man M-Q, Thornfeldt CR, Feingold KR: The epidermal permeability barrier: effects of physiologic and non-physiologic lipids; in Hoppe U (ed): The Lanolin Book. Hamburg, Beiersdorf, 1999, vol 3, pp 253–278.
  16. Rissmann R, Oudshoorn MH, Kocks E, Hennink WE, Ponec M, Bouwstra JA: Lanolin-derived lipid mixtures mimic closely the lipid composition and organization of vernix caseosa lipids. Biochim Biophys Acta 2008;1778:2350–2360.
  17. Clark EW, Blondeel A, Cronin E, Oleffe JA, Wilkinson DS: Lanolin of reduced sensitizing potential. Contact Dermatitis 1981;7:80–83.
  18. Basketter D, Darlenski R, Fluhr JW: Skin irritation and sensitization: mechanisms and new approaches for risk assessment. Skin Pharmacol Physiol 2008;21:191–202.
  19. Fluhr JW, Darlenski R, Angelova-Fischer I, Tsankov N, Basketter D: Skin irritation and sensitization: mechanisms and new approaches for risk assessment. 1. Skin irritation. Skin Pharmacol Physiol 2008;21:124–135.
  20. Duffy EP, Percival P, Kershaw E: Positive effects of an antenatal group teaching session on postnatal nipple pain, nipple trauma and breast feeding rates. Midwifery 1997;13:189–196.
  21. Buchko BL, Pugh LC, Bishop BA, Cochran JF, Smith LR, Lerew DJ: Comfort measures in breastfeeding, primiparous women. J Obstet Gynecol Neonatal Nurs 1994;23:46–52.
  22. Sherman SA, Eisen S, Burwinkle TM, Varni JW: The PedsQL present functioning visual analogue scales: preliminary reliability and validity. Health Qual Life Outcomes 2006;4:75.
  23. Levenstein S, Prantera C, Varvo V, Scribano ML, Berto E, Luzi C, Andreoli A: Development of the Perceived Stress Questionnaire: a new tool for psychosomatic research. J Psychosom Res 1993;37:19–32.
  24. Fliege H, Rose M, Arck P, Walter OB, Kocalevent RD, Weber C, Klapp BF: The Perceived Stress Questionnaire (PSQ) reconsidered: validation and reference values from different clinical and healthy adult samples. Psychosom Med 2005;67:78–88.
  25. Wockel A, Schumann M, Abou-Dakn M: Development of a wound score for the evaluation of cracked nipples during lactation. Arch Gyn Obst 2004;17(suppl 1):270.
  26. Herr K, Spratt KF, Garand L, Li L: Evaluation of the Iowa Pain Thermometer and other selected pain intensity scales in younger and older adult cohorts using controlled clinical pain: a preliminary study. Pain Med 2007;8:585–600.
  27. Armitage P: Theory and practice in medical statistics. Stat Med 2001;20:2537–2548.
  28. Groer M, Davis M, Casey K, Short B, Smith K, Groer S: Neuroendocrine and immune relationships in postpartum fatigue. MCN Am J Matern Child Nurs 2005;30:133–138.
  29. Groer MW, Davis MW: Cytokines, infections, stress, and dysphoric moods in breastfeeders and formula feeders. J Obstet Gynecol Neonatal Nurs 2006;35:599–607.
  30. Daeschlein G, Assadian O, Bruck JC, Meinl C, Kramer A, Koch S: Feasibility and clinical applicability of polihexanide for treatment of second-degree burn wounds. Skin Pharmacol Physiol 2007;20:292–296.
  31. Hughes-Formella B, Wunderlich O, Williams R: Anti-inflammatory and skin-hydrating properties of a dietary supplement and topical formulations containing oligomeric proanthocyanidins. Skin Pharmacol Physiol 2007;20:43–49.
  32. Wockel A, Abou-Dakn M, Beggel A, Arck P: Inflammatory breast diseases during lactation: health effects on the newborn – a literature review. Mediators Inflamm 2008;2008:298760.
  33. Amir LH, Dennerstein L, Garland SM, Fisher J, Farish SJ: Psychological aspects of nipple pain in lactating women. J Psychosom Obstet Gynaecol 1996;17:53–58.
  34. Abou-Dakn M, Richardt A, Schaefer-Graf U, Wöckel A: Inflammatory breast diseases during lactation: milk stasis, puerperal mastitis, abscesses of the breast, and malignant tumors – current and evidence-based strategies for diagnosis and therapy. Breast Care 2010;5:33–37.

    External Resources

  35. Foxman B, D’Arcy H, Gillespie B, Bobo JK, Schwartz K: Lactation mastitis: Occurrence and medical management among 946 breastfeeding women in the United States. Am J Epidemiol 2002;155:103–114.
  36. Centuori S, Burmaz T, Ronfani L, Fragiacomo M, Quintero S, Pavan C, Davanzo R, Cattaneo A: Nipple care, sore nipples, and breastfeeding: a randomized trial. J Hum Lact 1999;15:125–130.
  37. Waldenstrom U, Aarts C: Duration of breastfeeding and breastfeeding problems in relation to length of postpartum stay: a longitudinal cohort study of a national Swedish sample. Acta Paediatr 2004;93:669–676.
  38. Dodd V, Chalmers C: Comparing the use of hydrogel dressings to lanolin ointment with lactating mothers. J Obstet Gynecol Neonatal Nurs 2003;32:486–494.
  39. Wockel A, Beggel A, Gensch M, Abou-Dakn M: Psychological stress and puerperal mastitis: possible pathophysical mechanisms. Curr Womens Health Rev 2007;3:123–127.