Risks of nipple care products

What are the risks of nipple creams?

If the nipples are normal, there’s no need for nipple creams and other products. They may even be harmful. If mothers have nipple pain or damage, there is a specific way to address it. Non-specific creams and ointments are less likely to work. Nipple damage is best treated with moist-wound healing using appropriate wound care products and by keeping the damage covered. Some products harm the delicate tissues in a damaged area and can stop or delay healing and cause pain. There is little research on the safety and effectiveness of many of the products sold for nipple pain and damage. Combination ointments have not been shown to be more effective than purified lanolin and may do harm. Some products can cause allergic reactions and others may be toxic to the baby.

A) Best practices

1) Normal nipples

Some mothers use nipple care products even when their nipples are normal. Research on their effectiveness is not consistent and their use may have risks.

2) Painful nipples

Mothers also use products to treat nipple pain. If you are breastfeeding and have nipple pain, there is usually a cause that can be identified.  Once you know the cause, you can fix the problem with a specific, effective approach.

Non-specific  nipple creams and ointments  are unlikely to be effective.

3) Damaged nipples

When nipple damage is healing, the tissues in the area are very delicate. Nipple damage is best treated with moist-wound healing using appropriate wound care products and by keeping the damage covered

Inappropriate products harm the delicate tissues in a damaged area of skin and can stop or delay healing and cause painProducts used on damaged skin need to be very gentle and should state that they are meant for healing skin (wound care products).

Other approaches such as air-drying or applying expressed breast milk can delay healing and cause more pain and other problems.

B) Background information

Many products, including lotions, creams, or ointments, are promoted for treating sore or damaged nipples. Some contain medication and are given by prescription while others are available for direct purchase. There is little research on their safety and effectiveness.

Such products contain ingredients that may produce an unwanted effect on the mother or baby. They can be:

  • The active agent, such as an antibiotic
  • A base ingredient, such as petrolatum (petroleum jelly)
  • An enhancer, such as a fragrance
  • A contaminant or undeclared ingredient (Health Canada 2017)

You may have information about the ingredients and products, but this will not protect you against unknown effects or undeclared ingredients.

C) Products that can cause allergic reactions

1) Ingredients that may cause allergic reactions

This is a partial list of items that may cause allergic skin reactions. If used on the areola, they may cause areolar eczema

  • Antibiotics such as neomycin, bacitracin, and mupirocin (Nguyen 2019)
  • Antifungals (Nguyen 2019)
  • Fragrances (Buckley 2000)
  • “Natural” products such as:
    • Tea tree oil (Hammer 2006; de Groot 2016)
    • Eucalyptus (Higgins 2015)
    • Arnica (Reider 2001)
    • Marigold and calendula (Arora 2013)
    • Camphor (Rubio-González 2015)
    • Lavender (Wu 2011)
    • Rosemary (Miroddi 2014)
    • Aloe vera (Alvarez-Perea  2010)
    • Peppermint (Bayat 2014; Calapai 2016)
    • Chamomile (Anzai 2015)
  • Vitamins A and E (Baumann 1999; Kosari 2010)
  • Regular and purified lanolin
  • Cleaning agents (Flyvholm 1993)
  • Steroid preparations 
  • Numbing agents (lidocaine; benzocaine)
  • Propylene glycol

2) Patch tests for allergic reactions

Allergic reactions may happen right away or take time to develop. The reaction may spread to areas not in contact with the ingredient.

You may try your own patch test to see if you are allergic before starting to use a product:

  1. Apply a small amount of the product to the inside of your forearm.
  2. Cover it with a non-stick dressing.
  3. Leave it for 24 hours.
  4. Remove the dressing and look for itching, redness, or changes in the skin.

If you think you are allergic to a skin preparation, stop using it immediately.

D) Using breast milk on nipples

1) Normal nipples 

Some mothers put expressed breast milk on their nipples even when their nipples are normal. There is no evidence of any benefit from this. It can leave the nipples dried onto a breast pad, causing pain when the pad is removed. If your nipples are not damaged or painful, they are best left alone.

2) Damaged nipples

Moist-wound healing has been found to speed the healing of damaged skin when compared to keeping the nipples dry. 

Using breast milk on damaged nipples without a non-stick dressing to cover it has an effect similar to that of air-drying as the milk is absorbed away from the damage and into a breast pad or bra. If left exposed to air, it will dry even more quickly.

One study (Vieira 2017) compared the use of purified lanolin on nipple damage to the use of breast milk by mothers who also covered their nipples with breast shells. It found the breast milk more effective at decreasing pain and promoting healing. While breast milk alone can dry the damaged area, the breast shells may have increased the moisture level, allowing for healing. More research is needed.

If you want to treat nipple damage with breast milk, consider covering the nipple with a non-stick dressing or with a breast shell to keep the nipple slightly moist and prevent sticking. 

This is different from using breast milk to wash off a medicated ointment, which is appropriate.

E) Combination ointment

Combinations of antibiotics, antifungal agents, and steroids (combination ointments; all-purpose nipple ointment [APNO]) are occasionally prescribed for nipple pain and damage. These have not been shown to be more effective than purified lanolin (Dennis 2012).

As each ingredient has risks, combination ointments can result in unnecessarily using several medications when only one is be needed. 

Antibiotics and antifungal medications are generally only used on infection or if the risk of infection is very high as routine use of these medications without infection can increase the risk of bacteria and fungi becoming resistant to drugs (Bessa 2016; Zaman 2017). Steroids can increase the risk of infection and thinning of the skin, among other side-effects

We have found combination ointments useful for small, infected, late-onset wounds that do not respond to moist-wound healing combined with antibiotic or antibacterial preparations. This has allowed us to avoid the use of stronger antibiotics by mouth. 

F) Products that can be dangerous for babies

1) Petrolatum and mineral oil

Humans cannot digest mineral oil paraffins, such as mineral oil and petrolatum (petroleum jelly), and these items remain stored in fat (Concin 2011). A breastfeeding baby will swallow them if they are on the nipple and areola (Noti 2003). The long-term effects of this are unknown (Anderson 2018). 

The European Union classifies petrolatum as a carcinogen and restricts its use in cosmetics (ECA 2020). Petrolatum can be contaminated with polycyclic aromatic hydrocarbons (PAHs). Studies suggest PAHs are associated with numerous types of cancer (Diggs 2011). 

PAHs in petrolatum can cause skin irritation and allergies (Ulrich 2004).

Petrolatum in larger amounts can be a choking risk for the baby.

2) Other possibly dangerous ingredients 

Other possibly dangerous ingredients used in nipple care products include:

  • Silver (can be toxic) (Hadrup 2014)
  • Iodine (can affect thyroid function) (Leung 2014)
  • Vitamin A (can be toxic) (Penniston 2006)
  • Vitamin E (can be toxic) (Di Mascio 1991)
  • Unpasteurized honey (can cause botulism)
  • Gentian violet (can burn the baby’s mouth; is considered a carcinogen)
  • Tea tree oil and lavender (may have hormonal effects) (Henley 2007)
  • Numbing agents (lidocaine; benzocaine)

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