Comparison of the Effects of Lanolin, Peppermint, and Dexpanthenol Creams on Treatment of Traumatic Nipples in Breastfeeding Mothers

Nonpharmacological Interventions for Treating Breastfeeding Nipple Pain: Systematic Review and Meta-Analysis

Objective: To evaluate the efficacy and safety of nonpharmacological topical interventions for treating breastfeeding nipple pain. Methods: Randomized clinical trials (RCTs) assessing lactating women suffering from breastfeeding painful nipples were included. Primary outcomes were pain, healing process, and adverse events. A comprehensive search was conducted on June 02, 2023, without date or language restrictions. Methodological quality was assessed using the Cochrane risk of bias tool and the certainty of the evidence, the GRADE approach. Results: Nineteen RCTs with unclear to high risk of bias were included. There was uncertain evidence regarding the effects of photobiomodulation versus placebo on pain reduction (mean difference [MD] -0.15; 95% confidence interval [95% CI] -1 0.49 to 1.19; 139 participants, 2 RCTs). There are uncertainties concerning the effects of lanolin versus breast milk on pain (MD -1.80; 95% CI -2.43 to -1.17; 1 RCT; 180 participants), wound healing (MD 0.10; 95% CI -0.26 to -0.46; 1 RCT; 180 participants), and any adverse events (zero events in both groups). Similar effects were observed by the other interventions assessed. Conclusion: The evidence of nonpharmacological topical interventions for painful nipples is imprecise, and future RCTs with higher methodological quality are needed to support recommendations. Considering the accessibility and low cost of these alternative treatments, the findings of this evidence synthesis could support clinical decision-making and guide future research. PROSPERO CRD42020170320.

Effect of Tea Tree Oil and Coconut Oil on Nipple Crack Formation in the Early Postpartum Period

Background: The aim of the study was to determine the effect of tea tree oil and coconut oil applied to the nipples during the early postpartum period on nipple crack formation. Methods: This randomized controlled experimental research included a total of 90 women in the research sample abiding by the research criteria, with 30 each in the intervention groups (coconut oil or tea tree oil application) and 30 in the control group. Women in the intervention groups applied coconut oil or tea tree oil to the nipples on the 3rd, 7th, and 10th days postpartum, whereas the control group did not have any intervention. Data in the research were collected with the Descriptive Information Form for Mothers, Early Postpartum Period Breast Problem Assessment Form, and Visual Analog Scale (VAS). Analysis of data used the chi-square test, Kruskal-Wallis test, and Friedman's test. Results: Mean age of women participating in the research was 28.23 ± 5.21 years. The differences between the groups applying coconut oil and tea tree oil on the 3rd, 7th, and 10th days postpartum and the control group were significant in terms of incidence of nipple cracks. In addition, the difference in mean VAS points for nipple pain in the groups using coconut oil and tea tree oil and the control group was found to be statistically significant (p < 0.05). Conclusions: According to the research findings, coconut oil and tea tree oil were determined to reduce nipple crack formation and nipple pain. It is recommended to increase the use of coconut oil and tea tree oil related to breast problems in nursing care during the postpartum period. Clinical Trials Registration Number: NCT05456438.

Natural Herbal Non-Opioid Topical Pain Relievers-Comparison with Traditional Therapy

Pain is the predominant symptom of many clinical diseases and is frequently associated with neurological and musculoskeletal problems. Chronic pain is frequent in the elderly, causing suffering, disability, social isolation, and increased healthcare expenses. Chronic pain medication is often ineffective and has many side effects. Nonsteroidal over-the-counter and prescription drugs are frequently recommended as first-line therapies for pain control; however, long-term safety issues must not be neglected. Herbs and nutritional supplements may be a safer and more effective alternative to nonsteroidal pharmaceuticals for pain management, especially when used long-term. Recently, topical analgesic therapies have gained attention as an innovative approach due to their sufficient efficacy and comparatively fewer systemic side effects and drug-drug interactions. In this paper, we overview the main natural herbal pain relievers, their efficacy and safety, and their potential use as topical agents for pain control. Although herbal-derived medications are not appropriate for providing quick relief for acute pain problems, they could be used as potent alternative remedies in managing chronic persistent pain with minimal side effects.

Cacao Butter as Prophylaxis for Nipple Problems: A Pilot Randomized Controlled Study

Objective: Cacao butter is a type of oil extracted from the fruit of the Theobroma Cacao plant. This study was conducted to compare the use of breast milk and cacao butter for the prevention of nipple problems in the early postpartum period. Materials and Methods: This randomized controlled study involved 72 participants, who were randomized into the cacao and mother's milk groups. Data were collected using Descriptive questionnaire, Nipple assessment form, and IMDAT (Amount of Urine Output, Condition of Breasts, Amount of Stool, Weight Increase and Satisfaction Status). Results: On postpartum day 10, the rates of nipple pain (11.40% cacao group versus 40.50% mother's milk group), rashes (14.30% cacao group versus 35.10% mother's milk group), and cracks (14.30% cacao group versus 43.20% mother's milk group) significantly reduced in the cacao group when compared with the mother's milk group (p < 0.05). Conclusion: The application of cacao butter to the nipples is possibly a more effective method than the application of mother's milk for preventing nipple pain, rashes, or cracked nipples. Cacao butter can be used prophylactically to prevent nipple problems in the early postpartum period.

Use of Dexpanthenol for Atopic Dermatitis—Benefits and Recommendations Based on Current Evidence

Background: Atopic dermatitis (AD) is an inflammatory skin disease of multiple phenotypes and endotypes, and is highly prevalent in children. Many people of all ages, including active adolescents, pregnant women, and the elderly, suffer from AD, experiencing chronicity, flares, and unexpected relapse. Dexpanthenol has multiple pharmacological effects and has been employed to treat various skin disorders such as AD. We aimed to summarize the up-to-date evidence relating to dexpanthenol and to provide a consensus on how to use dexpanthenol effectively for the treatment of AD. Methods: The evidence to date on the application and efficacy of dexpanthenol in AD was reviewed. The literature search focused on dexpanthenol use and the improvement of skin barrier function, the prevention of acute flares, and its topical corticosteroid (TCS) sparing effects. Evidence and recommendations for special groups such as pregnant women, and the effects of dexpanthenol and emollient plus in maintenance therapy, were also summarized. Results: Dexpanthenol is effective and well-tolerated for the treatment of AD. Dexpanthenol improves skin barrier function, reduces acute and frequent flares, has a significant TCS sparing effect, and enhances wound healing for skin lesions. Conclusion: This review article provides helpful advice for clinicians and patients on the proper maintenance treatment of AD. Dexpanthenol, as an active ingredient in ointments or emollients, is suitable for the treatment and maintenance of AD. This paper will guide dermatologists and clinicians to consider dexpanthenol as a treatment option for mild to moderate AD.

Biological Properties of Vitamins of the B-Complex, Part 1: Vitamins B1, B2, B3, and B5

This review summarizes the current knowledge on essential vitamins B₁, B₂, B₃, and B₅. These B-complex vitamins must be taken from diet, with the exception of vitamin B₃, that can also be synthetized from amino acid tryptophan. All of these vitamins are water soluble, which determines their main properties, namely: they are partly lost when food is washed or boiled since they migrate to the water; the requirement of membrane transporters for their permeation into the cells; and their safety since any excess is rapidly eliminated via the kidney. The therapeutic use of B-complex vitamins is mostly limited to hypovitaminoses or similar conditions, but, as they are generally very safe, they have also been examined in other pathological conditions. Nicotinic acid, a form of vitamin B₃, is the only exception because it is a known hypolipidemic agent in gram doses. The article also sums up: (i) the current methods for detection of the vitamins of the B-complex in biological fluids; (ii) the food and other sources of these vitamins including the effect of common processing and storage methods on their content; and (iii) their physiological function.

Effects of Herbal Medicines on Nipple Fissures: A Systematic Review

Context: As a prevalent problem on the first days of childbirth, nipple fissures can cause pain and discomfort and lead to the early cessation of breastfeeding. Effectively treating this complication is therefore crucial. This systematic review investigated the effects of herbal medicines on the treatment of nipple fissures. Data Sources: Keywords such as “treatment”, “nipple fissure”, “fissure”, “medicinal plants”, “sore nipple” and “herbal ingredients” were used individually and in combination to extract relevant articles published by March 2020 from English databases, i.e., Science Direct, PubMed, Scopus and Google Scholar. The Persian equivalents of these keywords were used for extracting articles from Google Scholar, SID and Magiran. The selected articles were qualitatively evaluated using the checklist issued by Consolidated Standard of Reporting Trials (CONSORT) in 2017. Results: Out of 132 articles retrieved, 10 eligible ones were included in this study. Investigating the full text of the articles found herbal medicines such as purslane, Aloe vera, olive oil, frankincense, Pistacia atlantica, curcumin and Ziziphus jujuba effective in treating nipple fissures. Conclusions: Given the effects of herbal medicines on treating nipple fissures, it is recommended that comprehensive studies be conducted on different forms and doses of these compounds.

Postpartum Nipple Symptoms: Risk Factors and Dermatologic Characterization

Background: Nipple discomfort inhibits breastfeeding goals, particularly between 0 and 8 weeks postpartum (PP), and yet the specific dermatologic entities that contribute to nipple soreness have not been clearly delineated. Moreover, there remains a lack of evidence-based guidelines for nipple symptoms and skin diseases. Methods: A survey was distributed to 6-8-week PP women, 18-50 years of age, with an intent to exclusively or partially breastfeed ("at the breast" or "pump"). The study aimed to characterize nipple skin symptoms (pain and itching) and lesions (eczema, redness, cuts, or wounds) and any association between these nipple problems and past dermatologic history, breastfeeding outcomes, and the ability to meet her breastfeeding goals. Results: Findings paralleled Centers for Disease Control and Prevention (CDC) statistics with a 25% decline in breastfeeding rates between birth, 86.3% (189), and 6-8 weeks PP, 64.5% (145). By 6-8 weeks PP, exclusive "formula" and "exclusive feeding at the breast" showed the largest increase (+16.4%) and decrease (-22.9%), respectively. Although no significant difference was found in comparison of nipple problems to feeding methods or skin history, women who reported pumping or PP redness/eczema had higher odds ratios of a change in feeding practice, history of eczema, and sensitive skin. Strong pumping intentions were also associated with the highest risk of unmet breastfeeding goals. Conclusion: Regardless of feeding method, product, or provider use, PP nipple problems predominantly arose between 1 and 3 weeks PP. Clinical Trial Registration number 201901737.

Comparison of the effects of olive oil and breast milk on the prevention of nipple problems in primiparous breastfeeding women: a randomized controlled trial

We aimed to determine the effects of olive oil and breast milk on the prevention of nipple problems in this study. This study was conducted on 120 primiparous breastfeeding mothers. The mean scores for nipple pain demonstrated a statistically significant difference between the olive oil group and the control group (p = .006) and nipple damage was significantly less in the olive oil group (p = .003) on the 7^th day of the follow-up. Our results illustrated that olive oil was effective in reducing pain severity and preventing the formation of nipple crack compared control group.

Dexpanthenol in Wound Healing after Medical and Cosmetic Interventions (Postprocedure Wound Healing)

With the availability of new technologies, the number of subjects undergoing medical and cosmetic interventions is increasing. Many procedures (e.g., ablative fractional laser treatment) resulting in superficial/minor wounds require appropriate aftercare to prevent complications in wound healing and poor cosmetic outcome. We review the published evidence of the usefulness of topical dexpanthenol in postprocedure wound healing and the associated mechanisms of action at the molecular level. A search in the PubMed and Embase databases was performed to query the terms dexpanthenol, panthenol, superficial wound, minor wound, wound healing, skin repair, and postprocedure. Search results were categorized as clinical trials and in vitro studies. In vitro and clinical studies provided evidence that topically applied dexpanthenol promotes superficial and postprocedure wound healing. Latest findings confirmed that dexpanthenol upregulates genes that are critical for the healing process. The gene expression data are of clinical relevance as evidenced by prospective clinical studies indicating that topical dexpanthenol accelerates wound healing with rapid re-epithelialization and restoration of skin barrier function following skin injury. It can therefore be inferred that topical dexpanthenol represents an appropriate and state-of-the-art treatment option for superficial postprocedure wounds, especially when applied early after the superficial skin damage.

Comparing the effects of yarrow, honey, and breast milk for healing nipple fissure

Background:

Nipple fissure is a common problem among breastfeeding women, which can lead to early cessation of breastfeeding. Because of the lack of effective treatment and given the approved efficacy of honey and yarrow on sore healing, this study was conducted to evaluate and compare the effects of yarrow, honey, and breast milk on the treatment of nipple fissure.

Materials and Methods:

This study was a three-group clinical trial, and sampling was conducted at Sina breastfeeding counseling center from September 2016 to March 2018 in Sirjan, Iran, using a target-based method. The sample size consisted of 150 individuals who were randomly assigned into three groups as topical use of yarrow, the mountain honey, and breast milk after obtaining the written informed consent. The correct method of breastfeeding and using materials were instructed to these three groups on the 1^st, 3^rd, and 7^th days, where the Storr scale was completed by the researcher.

Results:

Friedman test showed that, in these three groups of yarrow (χ² = 92.19, df = 2, p < 0.001), honey (χ² = 93.29, df = 2, p < 0.001), and breast milk (χ² = 90.51, df = 2, p < 0.001)); severity of fissure had a significant reduction. Nevertheless, Kruskal–Wallis test revealed no significant difference among the severity of fissure scores in these three groups (p > 0.05).

Conclusions:

Use of honey, yarrow, and breast milk can be recommended to women in breastfeeding counseling and pharmaceutical companies can be advised to use honey and yarrow in the preparation of anti-fissure creams.

A combination of mupirocin and acidic fibroblast growth factor for nipple fissure and nipple pain in breastfeeding women: protocol for a randomised, double-blind, controlled trial

INTRODUCTION

Nipple fissure and nipple pain are common complaints among breastfeeding mothers. Studies found that mupirocin was effective in preventing and treating infections of damaged nipple and nipple pain. Acidic fibroblast growth factor (aFGF) plays an important role in wound healing. However, current evidence on the efficacy and safety of mupirocin plus aFGF for nipple fissure and nipple pain in breastfeeding women is inconclusive due to the lack of well-designed randomised controlled trials on this topic. The purpose of this study is to test the hypothesis that mupirocin plus aFGF is more effective than mupirocin alone for nipple fissure and nipple pain in breastfeeding women.

METHODS AND ANALYSIS

This study is a randomised, double-blind, single-centre, parallel-group clinical trial. A total of 120 breastfeeding women with nipple fissure and nipple pain will be randomly assigned to either mupirocin plus aFGF group or mupirocin plus placebo group according to a computer-generated random allocation sequence. The treatment period lasts 14 days. The primary outcome is nipple pain intensity measured by the Visual Analogue Scale on day 14 during the treatment period. Secondary outcome measures include time to complete nipple pain relief, changes in the Nipple Trauma Score, time to complete healing of nipple trauma, quality of life measured by the Maternal Postpartum Quality of Life (MAPP-QOL) Questionnaire, the frequency of breast feeding, the rate of breastfeeding discontinuation, weight change in infants and adverse events.

ETHICS AND DISSEMINATION

The study has gained approval from the Ethics Review Committee of Tianjin Central Hospital of Gynaecology Obstetrics on 22 January 2018 (approval no. 2018KY001). We plan to publish our research findings in a peer-reviewed academic journal and disseminate these findings in international conferences. This study has been registered with the Chinese Clinical Trial Registry.

TRIAL REGISTRATION NUMBER

ChiCTR1800017248.

A Systematic Review on Prevention and Treatment of Nipple Pain and Fissure: Are They Curable?

Averagely 80% to 90% of breastfeeding women experience the nipple pain and fissures. The important factor for successful breastfeeding is to treat this problem. This study has done as a review with the aim of analysis of the clinical trials in the field of the prevention and treatment of the nipple fissures and pain due to the importance of breastfeeding. For this purpose, the key words of sore, nipples, fissure, trauma, wound, prevention, treatment, therapeutics, therapy, clinical trial, breastfeeding and their Persian synonyms and all of their possible combinations were searched in the national databases: SID and Iran Medex and Magiran, and in the international databases: PubMed, Scopus, Medline, Science direct by May 2017. The Jadad criterion was used to assess the quality of the articles and the articles with a score of 3 or more were included in this study. Finally, 48 clinical trials were reviewed that 17 of them (sample size 1801) scored 3 or more based on the Jadad criterion. Seven articles were also in the non- drug treatment group (sample size 491) and 2 articles in the drug treatment group (sample size 337) and 8 articles in the herbal treatment group (sample size 973).The results show that menthol and warm water compress as well as teaching the correct breastfeeding methods are effective treatments to prevent and treat the nipple pain and fissures. Moreover, applying the herbal medicine for prevention and treatment of the issues raised from breastfeeding may have beneficial such as Aloe vera, Portulaca olearacea. However, more studies with a great methodology are necessary to obtain more accurate evidence.

The effect of Saqez (Pistacia atlantica) ointment on the treatment of nipple fissure and nipple pain in breastfeeding women

BACKGROUND

Nipple fissure is a common problem in breastfeeding women, and the main reason for the early discontinuation of breastfeeding.

OBJECTIVE

To determine the effect of Saqez (Pistacia atlantica) ointment on the treatment of nipple fissure and nipple pain in breastfeeding women.

METHODS

This randomized clinical trial was conducted on 100 subjects admitted to the health centers in Tehran, Iran from mid-July to mid-November 2015. The subjects were randomly divided into two equal groups of 50 for the Saqez ointment group and the control group. The subjects were divided into the two groups through random allocation in Excel. The subjects were monitored on day 1, 3 and 7. Data were analyzed in SAS using the Cumulative Logit model and in SPSS-21 using Mann-Whitney, independent-samples t-test, the Chi square and Fisher's exact test.

RESULTS

No significant differences were observed between the two groups in terms of their demographic and fertility characteristics. The Cumulative Logit model showed that high levels of nipple fissure and pain were significantly less frequent in the Saqez group compared to the control group (p<0.001). There was about 83% reduction in the severity of fissure and 85 %in the severity of pain in the Saqez group compared to the control group (p<0.001).

CONCLUSION

Saqez ointment is more effective in the treatment of nipple fissures and pain than breast milk. As this study was done for the first time, judgment about the conclusive efficacy of Saqez ointment on the nipple fissure, needs further similar studies.

TRIAL REGISTRATION

The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT2015080723535N1.

FUNDING

The authors received no financial support for the research, authorship, and/or publication of this article.

Topical use of dexpanthenol: a 70th anniversary article

Approximately 70 years ago, the first topical dexpanthenol-containing formulation (Bepanthen™ Ointment) has been developed. Nowadays, various topical dexpanthenol preparations exist, tailored according to individual requirements. Topical dexpanthenol has emerged as frequently used formulation in the field of dermatology and skin care. Various studies confirmed dexpanthenol's moisturizing and skin barrier enhancing potential. It prevents skin irritation, stimulates skin regeneration and promotes wound healing. Two main directions in the use of topical dexpanthenol-containing formulations have therefore been pursued: as skin moisturizer/skin barrier restorer and as facilitator of wound healing. This 70th anniversary paper reviews studies with topical dexpanthenol in skin conditions where it is most frequently used. Although discovered decades ago, the exact mechanisms of action of dexpanthenol have not been fully elucidated yet. With the adoption of new technologies, new light has been shed on dexpanthenol's mode of action at the molecular level. It appears that dexpanthenol increases the mobility of stratum corneum molecular components which are important for barrier function and modulates the expression of genes important for wound healing. This review will update readers on recent advances in this field.

The effect of Saqez (Pistacia atlantica) ointment on nipple fissure improvement in breastfeeding women during one-month follow-up

OBJECTIVE

Painful nipple fissure is a troublesome problem for breastfeeding mothers. This study was conducted to evaluate the effect of saqez (Pistacia atlantica) ointment on the improvement of nipple fissure in breastfeeding women during one-month follow-up.

MATERIALS AND METHODS

This randomized controlled clinical trial was conducted on 100 eligible women who visited the selected health centers affiliated to Shahid Beheshti University of Medical Sciences, Tehran, Iran, from July 2015 to December 2015 during their postpartum period. A total of 100 subjects were randomly divided into two equal groups of 50 women grouped as saqez ointment group and breast milk group, and followed-up for one month. Both groups received face-to-face instructions on breastfeeding techniques. For severity of nipple fissure, Storr scale and to measure the intensity of pain, visual analog scale (VAS) were used.

RESULTS

The results showed that the two groups were matched in terms of demographic and obstetric characteristics. Mean of nipple fissure severity in ointment group (42.62) was lower than that of the control group (48.02), that was significantly different between the two groups (p=0.047). In addition, Mean nipple pain intensity in ointment group (40.57) was lower than that of the control group (49.81), but there was no significant difference between the two groups (p=0.056).

CONCLUSION

The present study showed that saqez ointment was more effective than breast milk in healing and controlling nipple fissures during one-month follow-up, without resulting in any side effects.