Lanolin for Nipple Pain in Breastfeeding Mothers

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To the Editor:
Although the health advantages of breastfeeding are well known, many new mothers give up the practice early in their baby's life. Low milk supply is often cited as a reason to stop breastfeeding later in the postpartum period.1 Among the main reasons for early cessation of breastfeeding are sore, cracked, or fissured nipples,2 which vary in incidence varying from 34% to 96%.3 An understanding of nipple pain and treatment options are needed to improve duration of breastfeeding and to systematically address the most frequent difficulties encountered by breastfeeding women.4 A variety of interventions have been used to either treat o prevent nipple pain and/or trauma associated with breastfeeding. These include topical creams, solutions or sprays, time-restricted breastfeeding, exposure of the nipples to dry heat or ultraviolet light and air drying, hardening of the nipple skin, and prenatal or postnatal breastfeeding education.5
Lanolin, an organic ester derived from sheep fleece after shearing, creates an air permeable temporary barrier and promotes moist wound healing when applied to injured skin.6 It has been shown to have anti-inflammatory, antimicrobial, skin protecting, and barrier repair properties. It is an effective emollient with a long history of safe and beneficial use in cosmetics and topical preparations.7 Women using lanolin during breastfeeding have reported significantly greater satisfaction, increased breastfeeding duration, and exclusivity rates at 12 weeks postpartum.1
A barrier to the use of lanolin for this indication has been the issue of allergy and sensitization, which has been the subject of numerous studies and reviews.6,8 Lanolin applied to the mothers' nipples may be ingested by the infant and having to remove the lanolin could exacerbate existing soreness or injury. Free lanolin alcohols present in lanolin are mainly responsible for any allergic reaction and the incidence of allergic reactions increases in combination with detergent residues.9 When lanolin is treated, and free alcohol levels are reduced to 1.5% and detergent content to near zero, the incidence of reactions to lanolin samples in lanolin sensitive patients falls to zero.10 Nevertheless, use in infants and for treatment of nipple pain or cracking during breastfeeding was no longer recommended unless purified lanolin was used.9,10
Highly purified anhydrous (HPA) lanolin has undergone a proprietary process during which impurities and allergenic components are removed rendering it free of odor, taste, bleaches, and preservatives.11,12 HPA lanolin can therefore be considered truly hypoallergenic,13 and it does not need to be removed before breastfeeding. HPA lanolin, combined with breastfeeding education, was more effective than expressed breast milk,1 combined with breastfeeding education, in reducing nipple pain and promoting healing of nipple trauma.
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