General Description

Lanolin is commonly used during lactation to alleviate sore and cracked nipples. Highly purified lanolin products have been shown to be effective in reducing nipple pain and improving healing time. It is equally as effective as nipple ointments containing other ingredients. Lanolin treatment does not appear to have any negative effects on breastfeeding duration, exclusivity rate, or the occurrence of mastitis. Patient satisfaction with lanolin treatment is high. However, more research is needed to fully understand the effects of lanolin on lactation and breastmilk.

Figure 1. Lanolin

Summary of Use during Lactation

Lanolin is commonly used during lactation to alleviate sore and cracked nipples experienced by breastfeeding mothers. Derived from sheep's wool, lanolin is a yellow fat that has been traditionally applied topically for this purpose. Highly purified lanolin products, such as HPA lanolin and Lansinoh, have undergone a refining process to remove pesticide and detergent residues, as well as reduce the levels of natural free alcohols to below 1.5%. These purification measures aim to enhance safety and minimize allergic reactions, although individuals with known wool allergies should still avoid using even highly purified lanolin. Research suggests that lanolin is effective in both preventing and treating nipple pain during breastfeeding. However, its efficacy in preventing nipple pain when initiated before delivery has not been consistently demonstrated. Studies comparing lanolin with other treatments, including breastmilk, hydrogel dressings, peppermint gel, aloe vera, and warm compresses, have shown mixed results in terms of effectiveness. Some studies have indicated that no treatment or application of breastmilk might be superior to lanolin, but more robust studies are needed to draw definitive conclusions. Several small-scale studies have explored alternative treatments and found olive oil to be more effective than lanolin in preventing sore nipples. Additionally, the application of lanolin to painful nipples did not reduce nipple pain compared to usual care in one study. Another study comparing lanolin application with breastmilk application plus a nipple shell found that the latter combination was more effective in managing nipple trauma and pain. A randomized study involving 180 mothers reported that highly purified lanolin (Lansinoh) was superior to expressed breastmilk in reducing pain and nipple trauma over a 7-day period. Furthermore, two moderately sized studies suggested that aloe vera and purslane were more effective than lanolin in treating sore nipples during breastfeeding. A comparative study of various highly purified lanolin products revealed that HPA lanolin exhibited the lowest level of contaminants and had a significantly higher degree of purification compared to Purelan. HPA lanolin also showed an extremely low level of free lanolin alcohols, indicating a superior purification process four times lower than that of Purelan. Moreover, HPA lanolin did not contain any detectable pesticide residues, whereas Purelan contained low levels of pesticide residues within permitted limits. In conclusion, lanolin is commonly used during lactation to alleviate sore and cracked nipples. Highly purified lanolin products have undergone extensive refinement to improve safety and reduce allergic potential. While lanolin appears effective in preventing and treating nipple pain, its comparative efficacy with other treatments remains inconclusive. Further research is needed to establish its effectiveness, particularly in comparison to breastmilk and alternative treatment options. ¹

Effects on Lactation and Breastmilk

Lanolin has been studied for its effects on lactation and breastmilk. In a randomized, double-blind trial, lanolin was compared to an all-purpose nipple ointment containing mupirocin 1%, betamethasone 0.05%, and miconazole 2%. Both treatments were found to be equally effective in reducing nipple pain, nipple healing time, breastfeeding duration, breastfeeding exclusivity rate, mastitis, nipple symptoms, side effects, and maternal satisfaction with treatment during the first two weeks postpartum. Another randomized trial compared lanolin application to usual care, which included various measures such as education or assistance by a health professional, the application of warm or cool compresses, analgesics, air drying the nipples, or the use of breast shields. A blinded observer assessed healing through 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. However, patient satisfaction with care was higher in the women who received lanolin. These studies suggest that lanolin is an effective treatment option for painful nipples during lactation and may improve patient satisfaction with care. However, more research is needed to fully understand its effects on lactation and breastmilk. ²

Reference

1. Lanolin. In: Drugs and Lactation Database (LactMed?). Bethesda (MD): National Institute of Child Health and Human Development; May 15, 2023.

2. Jackson KT, Dennis CL. Lanolin for the treatment of nipple pain in breastfeeding women: A randomized controlled trial. Matern Child Nutr. 2017;13:e12357.