Lanolin use while Breastfeeding

Summary of Use during Lactation

Lanolin is a yellow fat obtained from sheep's wool. It has traditionally been used topically to treat sore, cracked nipples during breastfeeding. Highly purified lanolin products (e.g., HPA lanolin, Lansinoh) have the pesticide and detergent residues removed and the natural free alcohols reduced to below 1.5% to improve safety and reduce the allergic potential.[1] However, even highly-purified lanolin should be avoided in patients with a known allergy to wool.

Lanolin appears to be effective for the prevention and treatment of nipple pain during breastfeeding,[2] but not as a preventative initiated before delivery.[3] Studies, most of which used Lansinoh, have not found lanolin to be consistently different in efficacy from application of breastmilk, hydrogel dressings, peppermint gel, aloe vera or warm compresses.[4-12] A meta-analysis concluded that application of nothing or breastmilk may be superior to lanolin, but good studies are lacking.[13] One small nonblinded study found olive oil to be superior to lanolin for prevention of sore nipples.[14] A study in women with nipple trauma and pain comparing application of lanolin after each feeding to application of breastmilk plus a nipple shell found that the breastmilk and shell were more effective than lanolin.[15] A randomized study comparing highly purified lanolin (Lansinoh) to expressed breastmilk in 180 mothers, found lanolin to be superior to breastmilk over a 7-day period in reducing pain and the nipple trauma score. A systematic review found two studies of moderate quality found aloe vera and purslane to be more effective than lanolin in treating sore nipples during breastfeeding.[16] A more recent meta-analysis of controlled trials found lanolin to be superior to routine care in the treatment of nipple pain and trauma.[17]

A study comparing the various highly purified lanolin products found that HPA lanolin (Lansinoh Laboratories Inc.), Purelan (Medela AG) and two lanolin EU monograph compliant ingredients (Pharmalan PH EU-SO-(RB) and Corona-8 SO-(RB) (Croda, Goole, UK). The EU monograph compliant ingredients had the lowest level of contaminants. HPA lanolin contained an extremely low level of free lanolin alcohols, indicating a high level of purification, which was fourfold lower than Purelan. The HPA lanolin did not contain any detectable pesticide residues. Purelan contained a number of pesticide residues (diazinon, piperonyl butoxide, triflumuron); however, the levels were low and within the permitted limits.[18]

Drug Levels

Maternal Levels. Relevant published information was not found as of the revision date.

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

Relevant published information was not found as of the revision date.

Effects on Lactation and Breastmilk

In a randomized, double-bind trial, lanolin was compared to an all-purpose nipple ointment containing mupirocin 1%, betamethasone 0.05%, and miconazole 2% for painful nipples while nursing in the first 2 weeks postpartum. The two treatments were equally effective in reducing nipple pain, nipple healing time, breastfeeding duration, breastfeeding exclusivity rate, mastitis and nipple symptoms, side effects or maternal satisfaction with treatment.[19]

A randomized trial in nursing women with damaged, painful nipples compared lanolin application to usual care, which was a variable mix of education or assistance by health professional, application of warm or cool compresses, analgesics, air drying the nipples or the use of breast shields. A blinded observer assessed healing via telephone calls to the mothers several times after randomization. No differences were found in nipple pain between the groups 4 to 7 days after randomization. No difference was found in breastfeeding self-efficacy at 4 days post-randomization or in the breastfeeding rates of the two groups at 4 and 12 weeks postpartum. Patient satisfaction with care was higher in the women who received lanolin.[20]

References

1.

Mohammadzadeh A, Farhat A, Esmaeily H. The effect of breast milk and lanolin on sore nipples. Saudi Med J 2005;26:1231-4. [PubMed: 16127520]

2.

Vieira F, Bachion MM, Mota DD, et al. A systematic review of the interventions for nipple trauma in breastfeeding mothers. J Nurs Scholarsh 2013;45:116-25. [PubMed: 23452043]

3.

Oliveira FS, Vieira F, Guimarães JV, et al. Lanolin and prenatal health education for prevention of nipple pain and trauma: Randomized clinical trial. Enferm Clin (Engl Ed) 2021;31:82-90. [PubMed: 33277168]

4.

Morland-Schultz K, Hill PD. Prevention of and therapies for nipple pain: A systematic review. J Obstet Gynecol Neonatal Nurs 2005;34:428-37. [PubMed: 16020410]

5.

Melli MS, Rashidi MR, Nokhoodchi A, et al. A randomized trial of peppermint gel, lanolin ointment, and placebo gel to prevent nipple crack in primiparous breastfeeding women. Med Sci Monit 2007;13:CR406-11. [PubMed: 17767120]

6.

Abou-Dakn M, Fluhr JW, Mo G, et al. Positive effect of HPA lanolin versus expressed breastmilk on painful and damaged nipples during lactation. Skin Pharmacol Physiol 2011;24:27-35. [PubMed: 20720454]

7.

Shanazi M, Farshbaf Khalili, A, Kamalifard M, et al. Comparison of the effects of lanolin, peppermint, and dexpanthenol creams on treatment of traumatic nipples in breastfeeding mothers. J Caring Sci 2015;4:297-307. [PMC free article: PMC4699508] [PubMed: 26744729]

8.

Dodd V, Chalmers C. Comparing the use of hydrogel dressings to lanolin ointment with lactating mothers. J Obstet Gynecol Neonatal Nurs 2003;32:486-95. [PubMed: 12903698]

9.

Pugh LC, Buchko BL, Bishop BA, et al. A comparison of topical agents to relieve nipple pain and enhance breastfeeding. Birth 1996;23:88-93. [PubMed: 8826172]

10.

Saeidi R, Tafazoli M, Gholami M, et al. New treatment for nipple soreness in breastfeeding mothers: A clinical trial study. Iran J Neonatol 2015;6:48-51. http://ijn​.mums.ac.ir​/issue_626_671_Volume+6​%2C+Issue+2%2C+Spring+2015.html

11.

Perić O, Pavičić Bošnjak A, Mabić M, et al. Comparison of lanolin and human milk treatment of painful and damaged nipples: A randomized control trial. J Hum Lact 2022;39:236-44. [PubMed: 36401521]

12.

Elagamy MAEE, Shahin MA, Elkhalek NKA. Effect of breast milk versus lanolin on healing of sore nipple among postnatal lactating mothers. Egyptian Journal of Health Care 2019;10:371-87.

13.

Dennis CL, Jackson K, Watson J. Interventions for treating painful nipples among breastfeeding women. Cochrane Database Syst Rev 2014;12:CD007366. [PMC free article: PMC10885851] [PubMed: 25506813]

14.

Gungor AN, Oguz S, Vurur G, et al. Comparison of olive oil and lanolin in the prevention of sore nipples in nursing mothers. Breastfeed Med 2013;8:334-5. [PubMed: 23249138]

15.

Vieira F, Mota DD, Castral TC, et al. Effects of anhydrous lanolin versus breast milk combined with a breast shell for the treatment of nipple trauma and pain during breastfeeding: A randomized clinical trial. J Midwifery Womens Health 2017;62:572-9. [PubMed: 28887855]

16.

Pezeshki B, Pouredalati M, Zolala S, et al. Comparison of the effect of aloe vera extract, breast milk, calendit-E, curcumin, lanolin, olive oil, and purslane on healing of breast fissure in lactating mothers: A systematic review. International Journal of Pediatrics (Mashhad) 2020;8:10853-63. doi:10.22038/ijp.2020.46125.3760 [CrossRef]

17.

Shetty AP, Halemani K, Issac A, et al. Effectiveness of the application of lanolin, aloe vera, and peppermint on nipple pain and nipple trauma in lactating mothers: A systematic review and meta-analysis. Matern Child Health J 2024;28:2013-25. [PubMed: 39436586]

18.

Bourdillon K, McCausland T, McCabe M. Multi-residue analysis of certain lanolin nipple care products for trace contaminants. BMC Chem 2023;17:8. [PMC free article: PMC9972635] [PubMed: 36849952]

19.

Dennis CL, Schottle N, Hodnett E, et al. An all-purpose nipple ointment versus lanolin in treating painful damaged nipples in breastfeeding women: A randomized controlled trial. Breastfeed Med 2012;7:473-9. [PubMed: 22428572]

20.

Jackson KT, Dennis CL. Lanolin for the treatment of nipple pain in breastfeeding women: A randomized controlled trial. Matern Child Nutr 2017;13:e12357. [PMC free article: PMC6865977] [PubMed: 27477840]

Substance Name

Lanolin

CAS Registry Number

8006-54-0

Drug Class

Breast Feeding

Lactation

Milk, Human

Cosmetics

Pharmaceutic Aids

Waxes