Given the high incidence of nipple pain (it seems most women experience it when they start breastfeeding1), it would be reassuring to know that something can be done to relieve it. At the breastfeeding antenatal class the midwife told us that there is no evidence for the effectiveness of most nipple creams, although there have been studies showing that Lansinoh (commercially available purified lanolin) helps, and this is the one to go for if you have a problem. This view was echoed by two other midwives (one of whom gave me some sachets) and an NCT breastfeeding counsellor. You can read about my experience of using this preparation in the nipple solutions 1 journal post, but suffice to say that it didn’t work for me.
So, what is the scientific evidence for the effectiveness of lanolin? Probably the first thing to mention is that most of the big brand off-the-shelf nipple creams are simply moisturizers, and as the midwife said, there aren’t any published clinical trials supporting their effectiveness. On top of this, most of them aren’t even safe to go in babies’ mouths, so have you have to clean them off first – not ideal. This isn’t the case for Lansinoh – as it is simply purified lanolin, it isn’t a problem if babies swallow it (although this in itself doesn’t mean it’s worth using, of course).
An article looking at various topical treatments for nipple pain reviews several studies testing the effectiveness of lanolin1. When compared with hydrogel dressings (designed to maintain a moist wound healing environment), lanolin does well. In one study, women treated with lanolin reported significantly less nipple pain and were less likely to suffer from infection than those using the dressings. In another, there was no difference in pain relief, but there were still fewer infections in the lanolin group. Evidence that lanolin is a useful treatment? Not necessarily. As neither of these studies had a control group where no treatment was given, all we can tell is that hydrogel dressings are a bad idea. A study looking at the effect of heat treatment (sunshine or heat lamps) suffers from a similar problem. Using lanolin with the heat treatment offered greater pain relief than using the heat treatment alone, but unfortunately there is no way of telling whether this is better than not using any treatment at all.
In fact, the three studies in the review that compared lanolin with a ‘no treatment’ baseline showed it to be no more effective than leaving the nipples alone. There is also evidence that lanolin offers no improvement over rubbing on expressed milk (which is also reported as being pretty useless at reducing pain). The article also reports some preliminary research indicating that glycerin gel is a better treatment for sore nipples than lanolin (although a later study has found no difference between the two2.
Two further studies also deserve a mention. One provides evidence that peppermint gel is better at preventing nipple cracks and pain than lanolin or a placebo gel3. Another shows that in certain circumstances applying lanolin not only offers no improvement, but might actually make things worse4. The study compared using lanolin cream or breast milk with not using a treatment. The results showed that the appearance of nipple wounds (cracks and fissures) was the same in each group. However, the women who applied breast milk or used no topical treatment recovered significantly faster than those using lanolin.
So, it seems you may be better off ignoring the health professionals’ advice to use a lanolin cream. If you want to keep your nipples trauma-free you may want to think about using peppermint gel, or alternatively go for the inexpensive option of not bothering to treat them at all.
January 14, 2009 at 11:36 am
[…] at all, recovered significantly faster than the ones using lanolin (for a longer discussion see the is Lansinoh a waste of money? […]
May 2, 2009 at 8:24 am
[…] said to prevent or relieve nipple pain and damage during the early days of breastfeeding, including lanolin, expressed breast milk and water compresses. Unfortunately, none as yet have been found to offer […]
January 13, 2011 at 5:26 pm
Lanolin doesn’t prevent anything. The only thing that prevents cracks is proper breastfeeding technique. Even then, there are factors that can cause cracks even with perfect latch – such as yeast, tongue-tie, etc.
What lanolin DOES do (and does very well) is to aid in the healing of already developed cracks. First step is to alleviate the cause of the cracks. Without doing this, lanolin won’t do a bit of good.
How it works – lanolin aids in decreasing the formation of scabs in cracks. When scabs form, the skin is stuck together – and then ripped apart when the baby latches on. This scab/rip mechanism redamages the skin at every nursing and delays healing. By stopping the scabbing process, the skin will heal quicker more effectively with less pain during nursing.
Air drying worsens this process because it promotes the formation of scabs.
When people say that lanolin isn’t helping, it is most likely due to the fact that they are air-drying before they apply it OR they are not using it enough. If they have scabs, they aren’t using it enough.
It makes me sad when I see articles like this because it takes away a very helpful healing option for mothers – and is based on incomplete information. Lanolin alone is not a magic bullet. But used in conjunction with a thorough evaluation and resolution of the original problem, it can be excellent in speeding the healing process.
January 14, 2011 at 8:08 pm
Hi Sherri, thanks for your comment. Would you be able to direct me to any research that demonstrates the beneficial healing effect of lanolin under these circumstances? You may have seen the post I wrote about moist wound healing when breastfeeding – to my knowledge lanolin hasn’t been shown to help with this.
January 14, 2011 at 10:25 pm
You can start with information here, which does quote related studies and also explains in detail moist would healing. http://www.lansinoh.com/uploads/pdf/HPA_BOOKLET_FINAL.pdf
I would like to say that I am not a representative of Lansinoh, nor do I sell their product. I have seen the effects in the 15 years I have been instructing mothers on the use of lanolin in my practice as an LC.
I read your article on moist would healing and the study on lanolin is flawed. The reason I say that is because the instruction for the mothers was not accurate. Applying lanolin 3 times per day is not sufficient to stop the scabbing process – so it is no surprise to me that they did not show positive effects.
Also, the method to determine “healing” needs to be clarified. Is healing complete closure of the skin? Is it the ability to nurse pain-free? If they were looking for closure of the skin, then of course, the lanolin-users will appear to have delayed healing because their skin is not held tightly together with a scab. And lanolin treated wounds do appear to stay open longer – BUT those mothers exhibit pain-free nursing and the edges of the wounds are clean and without exudate AND show normal granulation in the base of the wound. They heal from the bottom up – as all wounds treated with ‘moist wound healing’ do. It’s all about perspective. . .and accurate information gathering by researchers.
I do appreciate your work in trying to base your recommendations here on studies, but as an LC who participates in research projects, I can say that a study often neither proves nor disproves a theory. It is GREAT when we have a study that we can point to, but it should never totally replace years of experience.
January 15, 2011 at 3:00 pm
Here is another more recent study. . .
“Positive Effect of HPA Lanolin versus Expressed Breastmilk on Painful and Damaged Nipples during Lactation
M. Abou-Dakna, J.W. Fluhrb, c, M. Genscha, A. Wöckeld”
January 16, 2011 at 7:32 pm
Thanks for those references Sherri – I’ll take a look. It’s very interesting to have your perspective on this topic. There are, inevitably, gaps in the literature, and clinical experience is of great value in these situations.
I should also say to all my readers that I’m not trying to make recommendations, just to make the relevant scientific literature more accessible. As a research scientist I’m able to read and report on scientific studies, but as I don’t work professionally in this field, I can’t offer anything further than this. The summaries I write, which may look like recommendations, are only intended to sum up the results of the relevant studies, and as the literature grows, those summaries will change accordingly.
May 6, 2011 at 12:51 am
I used lanolin when I breastfeed. It is not actually a cream, but more of a wax; looks kinda like carmex in the jar. I did not have scabs, but they were sore from being moist all the time. I applied the ointment when ever I thought about during the day, usually several times a day. It worked great. I love the stuff. Occasionally the skin under my rings gets a raw feeling from moisture getting under them and I use the lanolin on them and they get better within a day or so. I would recommend lanolin to everyone, especially breastfeeding mothers. I would just recommend appling the ointment several times a day to prevent the scabs from forming.
April 23, 2013 at 2:46 am
I used it while breast feeding now I use it for everything else cracked feet, chapped lips minor abrasions of the kids, healing sunburn and it works it heals lips and skin faster than petroleum jelly and does wonders for cracked feet and diaper rash, it is my medicine box, beauty and hygiene routine staple, I always keep it in the car and in my backpack for college and in the drawer next to my bed and in my medical kit.
November 12, 2013 at 8:35 am
Anecdotal evidence through 3 generations of one family – my grandmother (who had her first child in 1900) used lanolin cream on her nipples during the last 3 months of her pregnancy as well as while nursing. She passed on the advice to my mother (who had her first child in 1946), who passed it on to me (my first was born in 1983). None of us had any problems with chapped, split or sore nipples. I am about to pass the information on to my niece who can choose to use it or not (her first child will arrive in 2014).
Not a scientific study of course, but an inexpensive way of preparing the nipples prior to birth as well as conditioning them during breastfeeding which, within our family, has proven effective across the generations.
February 13, 2017 at 6:35 pm
Lansinoh is made of wool fat. I am allergic to wool. I rarely wear sweaters and do not wear wool socks. No rugs in our house today contain wool. [I have a son that has sensitive skin too. He would never admit to it.]
I wish I could tell more women. However, I am putting this in writing for the first time now. I have 3 kids, and for the first two used Lansinoh, the purple tube ointment, on my breasts religiously. I was told to do so by the lactation consultant at the hospital. I read the instructions on the large piece of paper inside the box. Read the box. Read the tube. No where does it say wool.
From the manufacturer:
Lansinoh HPA Lanolin Cream
Recommended by Lactation Consultants
Soothes and protects sore, dry and cracked nipples
World’s purest lanolin – safe for mom and baby
100% natural, single ingredient product – Preservative free
Used by and recommended by breastfeeding moms
Information about the product reads:
#1 recommended nipple cream by Lactation Consultants and doctors in the US
Soothes and protects sore and cracked nipples
World’s purest lanolin – safe for mom and baby
Hypoallergenic, no need to remove before breastfeeding
Lansinoh For Breastfeeding Mothers
The safety and purity of Lansinoh is not available in any other lanolin product
Safe for Baby Relief for Mother
You can read the container itself, the box, and the inside papers like I did.
Luckily one day, my mother (a gerontological nurse and mother of 9) was sitting with me and read the box. On the ingredients, it stated that it contained lanolin. Lanolin is wool fat. I had mastitis 3 times, and it is very painful. I was on antibiotics constantly. My second child had skin issues, that were not resolved by Dreft and many other attempts. When I stopped using Lansinoh, I enjoyed my third child’s breastfeeding with no pain. My second son has no skin issues now. Sad to find out so late.
Did you know, lanolin was wool fat, wax, or grease? It should be printed somewhere on the product. You want to inform us, then let us know what lanolin is.