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The Effect of Dexpanthenol on the Treatment of Nipple Injuries in Breastfeeding Mothers: A Randomized Control Trial

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Background: Considering the importance of treatment of sour nipples in breastfeeding mothers, the aim of this study was to evaluate the effect of dexpanthenol creams on the treatment of traumatic nipples. Materials and Methods: This study was a double-blinded, randomized, control trial, in which 82 postpartum mothers with nipple injuries who had attended health centers and Children’s Hospital of Sanandaj, Iran, participated. The participants were randomly divided into two groups of dexpanthenol and control. Nipple pain and trauma was measured using Storr and Champion scale. Analysis was done through chi-square and ANOVA tests using SPSS software version 13.0. P value less than 0.05 was considered significant. Results: The results of this study demonstrated that the mean score of pain and trauma in third, seventh, and fourteenth days of study in intervention group was decreased. In addition, there was significant differences in pain and trauma scores between dexpanthenol and control groups. Conclusion: Dexpanthenol is advised as an effective, simple, and non-invasive technique with no side effects for the treatment of nipple fissures and pain.
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Journal of Caring Sciences, 2015, 4(4), 297-307
doi:10.15171/jcs.2015.030
http:// journals.tbzmed.ac.ir/ JCS
*Corresponding Author: Kazhal Masoudin (MSC), email: k_masoudin@yahoo.com. This project was approved and funded by the
Tabriz University of Medical Sciences (Project number: 452).
© 2015 The Author(s). This work is published by Journal of Caring Sciences as an open access article distributed
under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc/4.0/). Non-commercial
uses of the work are permitted, provided the original work is properly cited.
دادا
Comparison of the Effects of Lanolin, Peppermint, and Dexpanthenol
Creams on Treatment of Traumatic Nipples in Breastfeeding Mothers
Mahnaz Shanazi1, Azizeh Farshbaf Khalili2, Mahin Kamalifard1, Mohammad Asghari Jafarabadi3,
Kazhal Masoudin1*, Fariba Esmaeli4
1Department of Midwifery, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
2Department of Midwifery, Tabriz Health Services Management Research Centre, Nursing and Midwifery Faculty, Tabriz
University of Medical Sciences, Tabriz, Iran
3Department of Biostatistics & Epidemiology, Road Traffic Injury Research Center, Tabriz University of Medical Sciences,
Tabriz, Iran
4Information Technology, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
ARTICLE INFO
ABSTRACT
Article Type:
Original Article
Introduction: Traumatic nipple is among the most common problems of the
breastfeeding period which leads to early cessation of breastfeeding. The study aimed
to compare the effects of the lanolin, peppermint, and dexpanthenol creams on the
treatment of traumatic nipples
Methods: This double-blind randomized controlled trial was carried out on 126
breastfeeding mothers. The mothers had visited at the health centers and children’s
hospitals in Sanandaj City. The selected participants were randomly divided into the
following three groups of lanolin, peppermint, and dexpanthenol cream groups. Nipple
pain was measured using the Store scale while trauma was measured with the
Champion scale. Analyses were carried out through the KruskalWallis test, Chi-
square, ANOVA, and repeated measures ANOVA by using SPSS software ver. 13.
Results: The result showed that the mean score of nipple pain and nipple trauma at the
prior to intervention stage, third, seventh, and fourteenth days of intervention was not
significantly different between three groups. But, repeated measures ANOVA showed
a significant difference in comparison of the four time periods of intervention in each
group.
Conclusion: Results of this study revealed that the lanolin, peppermint, and
dexpanthenol medicines had similar therapeutic effects on traumatic nipple.
Article History:
Received: 30 Apr. 2015
Accepted: 27 Sep. 2015
ePublished: 1 Dec. 2015
Keywords:
Lanolin
Peppermint
Dexpanthenol
Nipples
Breast Feeding
Please cite this paper as: Shanazi M, Farshbaf Khalili A, Kamalifard M, Asghari Jafarabadi M, Masoudin K, Esmaeli F. Comparison of the
effects of lanolin, peppermint, and dexpanthenol creams on treatment of traumatic nipples in breastfeeding mothers. J Caring Sci 2015; 4
(4): 297-307. doi:10.15171/jcs.2015.030.
Introduction
Breastfeeding, especially Exclusive Breast-
Feeding (EBF), is the ideal method for
feeding and growth in the first 6 months of
birth.1 Breast milk not only reduces the risk
of incidence of many acute and chronic
diseases such as diarrhea and respiratory
infections in breast-fed infants, but also it
has numerous benefits to mothers (for
example, the reduced risk of breast cancer,
uterus cancer, ovarian cancer, and
osteoporosis).1,2
Among all the possible problems arising
during the breastfeeding period, breast
conditions and those occurring in the early
days of breastfeeding are most important.3
Nipple problems include the development
of macroscopic lesions that occurs on the
nipples and areola. These lesions may
appear as eroded skin, wounds, and fissure
as well as clinical signs of erythema, edema,
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298 | Journal of Caring Sciences, December 2015; 4 (4), 297-307
white or yellow blisters, dark spots, and
ecchymosis.3,4
Traumatic nipples pose threats to
mothers, infants and societies. The most
common consequences of traumatic nipples
include infants’ deprivation of breast milk
benefits and it may lead to stress and
dissatisfaction in mothers. Studies indicate
that problems occurring in the first days
following birth may lead to the cessation of
breastfeeding. Moreover, according to the
statement issued by the World Health
Organization (WHO), less than 40% of
infants below 6 months of age are
exclusively fed by breast milk.5,6
The incident of traumatic nipples varies
between 29% and 76%, while nipple pain
caused from breastfeeding varies between
34% and 96%.7-9 Few studies have been
carried out to study the treatments of
traumatic nipples.10 It is estimated that 80%
to 90% of breastfeeding women experience
mild nipple pain. If these pains remain
untreated, 26% of nipple pains will develop
into nipple fissure and severe pain.11
Unfortunately, treatment of traumatic
nipple is complicated because of the
repeated sucking by the infant, infections
caused by the entrance of microorganisms
through the nipple fissure, and constant
exposure of nipple skin with the infant’s
oral flora.12,13
Treatment of traumatic nipple dates back
to the seventeenth century, but there is no
explicit statement on the most suitable
topical treatment for traumatic nipples.1 In
this regard, complementary medicine,
especially herbal medicine, plays a major
role in improving the quality of postpartum
care. Currently, 40% of common medicines
are derived from plants and natural
resources.14
Among the available treatments, lanolin
improves traumatic nipples through giving
moisture to the nipples. Lanolin penetrates
to the skin and facilitates the absorption of
medicines. This composition is capable of
absorbing up to 30% of water.15
In 2008, Dennis indicated that the
application of lanolin is effective for the
treatment of sore nipples. He stated that
lanolin along with teaching the correct
breastfeeding technique is the best solution
to the treatment of nipple fissure.9 In
contrast, Gartner showed that recovery of
nipple fissure in the lanolin group took
longer.11 In another study, Dodd &
Chalmens carried out a comparison
between the effects of hydrogen dressing
and lanolin on the treatment of traumatic
nipples and showed that the hydrogen
dressing group experienced a significant
decrease in pain as compared to the lanolin
group.16 However, no significant difference
was observed in wound healing between
two groups.
Dexpanthenol is one of the skin healers
which belongs to the family of B complex
vitamins. This medicine functions as a
moisturizer by reducing water loss through
the epidermis and maintaining the softness
and elasticity of the skin. Kusch indicated
that dexpanthenol is effective in the
prevention of nipple pain.17 Peppermint
herb which is a native plant to Iran, is
widely used for the treatment of skin
numbness, burns, scars, itching and
inflammation.8 In 2003, Ahluwalia made a
comparison between the contributions of
peppermint, lanolin, and teabag to the
treatment of traumatic nipples and reported
a significant decrease in pain and a
significant increase in the nipple trauma
healing of the peppermint group.They
concluded that peppermint increases tissue
flexibility and prevents fissure.18
In another study, Sayyah Melli showed
that the administration of peppermint juice
was three times more effective than breast
milk in the prevention of nipple fissure.
However, lanolin was less effective than
peppermint.12 In 2014, Akbari indicated that
peppermint essence can improve nipple
fissure in primiparous women.19
After a vast review of the existing
literature, no study was found to have
Effects of herbal drugs on treatment of traumatic nipples
Journal of Caring Sciences, December 2015; 4 (4), 297-307 |299
confirmed the effects of dexpanthenol and
peppermint on the treatment of traumatic
nipple in Iran, as all of the studies in this
country were conducted on the prevention
of trauma.
Considering the high prevalence of
traumatic nipple and its complications, the
lack of any agreed treatment for traumatic
nipples, and the necessity of early treatment
of traumatic nipples with the lowest side
effects, the present study was carried out to
compare the effects of lanolin, peppermint,
and dexpanthenol creams on the treatment
of traumatic nipples
Materials and methods
This randomized controlled trial conducted
to compare the effects of lanolin,
peppermint, and dexpanthenol on the
treatment of traumatic nipples in
breastfeeding mothers.
The target population included the
breastfeeding mothers who visited at the
Abbas Abad and Farabi health centers and
Sanandaj children’s hospital in 2014. These
centers were selected for this study because
the number of breastfeeding mothers
visiting these centers was high.
Based on the research by Ahluwalia et
al.,18 the sample size was calculated to be 35
for each group by confidence interval of
95% and statistical power of 80% and using
the three-group comparison formula.
Finally, by considering a sample loss of
20%, 42 women were selected in each
group.
The research samples were all of the
breastfeeding mothers, who visited at the
children’s hospital and health centers and
who had no drug prohibitions. After
obtaining the permission of the Ethics
Committee and the research deputy of
Tabriz Medical Sciences University, the
samples were selected from breastfeeding
mothers, who met the inclusion criteria and
visited at the Abbas Abad and Farabi health
centers and Sanandaj children’s hospital.
After explaining the research and its
method and objectives to the mothers, the
written consent was obtained from all
participants. Afterwards, the personal and
social information forms were completed
and midwifery histories of the subjects were
recorded. The forms and records were
completed based on the observation of the
breastfeeding methods of the mothers using
the Store and Champion scales. The
samples were finally selected based on the
following inclusion criteria: 1) primiparous
mothers; 2) exclusive feeding with breast
milk; 3) term infant; 4) infant with below
two months of age; 5) obtaining the
minimum score of 1 from the Store and
Champion scales; 6) mothers free of any
medical disorders; 7) lack of sensitivity of
mothers to lanolin, peppermint, and
dexpanthenol; 8) infant weight of 2500 to
4000 grams; and 11) lack of any nipple
disorders (flat and depressed nipples). The
exclusion criteria included the followings:
1) infants suffering from tongue and tooth
disorders; 2) using pacifiers, bottles, and
plastic nipples for infants; 3) history of
maternal psychological disorders reported
by mothers; and 4) mother or infant
suffering from any nipple-irrelevant
condition that lead to cessation of
breastfeeding.
Consort guidelines were followed in this
research. The samples were randomly
assigned into the lanolin, peppermint and
dexpanthenol groups. The allocation
sequence was determined by a computer-
generated randomization scheme with the
block sizes of 3 and 6 and the allocation
ratio 1:1:1. Then, the tubes were filled with
50 mL of lanolin, lanolin, or dexpanthenol
by the Laboratory of Pharmaceutics of
Tabriz School of Pharmacy. They were put
in pockets and numbered by the research
supervisor.
The lanolin tube contained pure lanolin
without additives. The peppermint tube
contained carbopol, methylparaben,
triethanolamine, and glycerin along with
Shahnazi et al.
300 | Journal of Caring Sciences, December 2015; 4 (4), 297-307
0.2% of peppermint oil, and the
dexpanthenol tube contained 5% B complex
analogue. Every woman entering the study
received sealed, opaque pockets (of
apparently similar sizes). Numbers ranging
from 1 to 126 were printed on the pockets
with identical uniform tubes. The pockets
included three types of cream: lanolin
cream, peppermint cream, and
dexpanthenol cream. The subjects were
randomly assigned into three groups
receiving lanolin, peppermint, and
dexpanthenol, and neither the researcher
nor the subjects were aware of the
assignment sequence and the position of
each subject. That is to say, this study was a
double blind trial.
The breastfeeding mothers were not
allowed to use any other treatment method
during the study period and they were
asked to report any case of sedatives
consumption during the study. The
participants were asked to apply a thin
layer of the cream to the traumatic nipple
and its areola three times a day
immediately after breastfeeding for two
weeks. The participants had
recontamination of hand washing with
warm water and soap before applying the
cream.
The information was collected through
four steps (prior to intervention and on the
third day, seventh day, and fourteenth day).
The participants, who were trained on
completion of the Store and Champion
scales in advance, completed the scales on
the third, seventh, and fourteenth days and
submitted them to the researcher on the
fourteenth day (the appointment day). The
researcher completed the forms at least
once. In addition, a follow-up appointment
was set for all of the participants one week
after entering the research to record the
intake of any sedatives or development of
any complication caused by the treatment.
The patients were given a cell phone
number to be able to call and ask any
questions related to the disease during the
daytime until 12 AM. The data collection
instrument consisted of three parts.
The first part questioned the demographic
and social information and the maternal
history of subjects. This questionnaire
covered information such as the patient age,
marriage age, marital status, education,
profession, residence location, midwifery
information (including the number of
pregnancies, number of delivery, number of
living children), history of medical
surgeries and history of breastfeeding
(number of infants, duration of
breastfeeding period, sedatives received for
breastfeeding pains, treatment effect,
breastfeeding status, and breast care during
pregnancy, following birth and during
breastfeeding). The positive response (Yes)
was assigned the 1 score while the negative
response (No) was assigned the 0 score. The
questionnaire was completed through
interviews before the intervention. The
second instrument which used to collect
data was the Storre scale. This scale was
designed to measure nipple pain. The
breastfeeding mothers measured their pain
using this scale and its numerical scale.
Score 0 was assigned to no pain and score 5
(the maximum score) was assigned to the
highest level of pain.20 The third instrument
for data collection was the Champion scale.
This scale was designed to identify and
rank nipple trauma. It is also used to assess
the recovery of wound depth and the extent
of damage caused to the tissue. The
breastfeeding mothers used this scale and
its numerical scale to assess the extent of
nipple trauma and its recovery.18
Lack of trauma was assigned the 0 score
and larger numbers were recorded for
deeper traumas. The scale ended with the
maximum score (being 5).9 Champion scale
(NTS) to assess Trauma healing of the
nipple. This tool has been used in various
studies inside and outside the country, and
its validity have been confirmed by
Champion.18 Storr scale (NSRS) to assess
soreness healing of the nipple. This tool has
Effects of herbal drugs on treatment of traumatic nipples
Journal of Caring Sciences, December 2015; 4 (4), 297-307 |301
been used in various studies inside and
outside the country, and its validity have
been confirmed by Storr.20 The reliability of
the Store and Champion scales was
measured using the test-retest method
(r>0.7).18 The data was analyzed using SPSS
software ver.13 and the following test
methods: test-retest method, Kruskal
Wallis method, Chi-square test, ANOVA,
and repeated measures ANOVA. The
significance level was assumed to be
P<0.05.
Results
In this clinical trial, 150 breastfeeding
mothers were assessed were assessed for
eligibility and finally 126 mothers were
included in the research (Figure 1).
Results of this study revealed that the three
study groups were similar in demographic,
social, and fertility properties. The mean
(SD) age of study samples in the lanolin,
peppermint, and dexpanthenol groups was
27.7 years (8.6), 27 years (6.1), and 27.2 years
(5.9), respectively. The mean (SD) marriage
age was 19.8 years (4.4), 20.4 years (3.5), and
21.6 years (4.2) for the lanolin, peppermint,
and dexpanthenol groups, respectively.
Table 1 shows and compares the
demographic data between three groups.
More than half of mothers in the three
groups had delivered once, and only in the
dexpanthenol group 3 mothers (7.8%) had a
history of four deliveries or more. Most
mothers in the three groups had just
delivered their first infants and most of the
mothers had an experience of natural
childbirth. Only 8 (20%), 4 (9.5%), and 7
(16.7%) patients in the lanolin, peppermint,
Figure 1. Consort flow diagram
Shahnazi et al.
302 | Journal of Caring Sciences, December 2015; 4 (4), 297-307
The mean (SD) score of nipple pain in the
lanolin, peppermint, and dexpanthenol
groups prior to intervention was 3.12 (0.93),
3.07 (1.02), and 3.07 (1.02), respectively. The
mean (SD) score of nipple pain on the third
day of intervention was 1.29 (0.60), 1.26
(0.54), and 1.33 (0.65) for the lanolin,
peppermint, and dexpanthenol groups,
respectively. The mean (SD) nipple pain on
the seventh day of intervention was 0.24
(0.49), 0.21 (0.47), and 0.14 (0.42) for the
lanolin, peppermint, and dexpanthenol and
dexpanthenol groups had a history of
cesarean section. Most mothers in the three
groups had no history of previous surgeries
and only one participant in the
dexpanthenol group (2.6%) had surgery
history (Table 1).
groups, respectively. More than 80% of
mothers entered the painless phase on the
seventh day of intervention. The number of
mothers who entered the aforementioned
stage was 32 (78%), 33 (80.5%), and 37
(88.1%) in the lanolin, peppermint, and
dexpanthenol groups, respectively. On the
fourteenth day of intervention 100% of
mothers in three groups entered the
painless phase.
The result showed that the mean score of
nipple pain at the prior to intervention stage,
third, seventh, and fourteenth days of
intervention was not significantly different
between three group (P>0.05). But, repeated
measures ANOVA showed a significant
difference in comparison of the three time
periods of intervention in each group
(P<0.001) (Table 2).
The mean (SD) nipple trauma score prior
to invention was 3.41 (0.89), 3.38 (0.89), and
3.36 (1.10) for the lanolin, peppermint, and
dexpanthenol groups, respectively. One
patient (2.4%) in the peppermint group and
4 patients in the lanolin and dexpanthenol
groups (9.5%) experienced the worst nipple
trauma conditions. The mean (SD) nipple
trauma score on the third day of
intervention was 2.00 (0.67), 2.09 (0.73), and
1.88 (0.77) for the lanolin, peppermint and
dexpanthenol groups, respectively. One
patient in the lanolin group (2.4%) and 2
patients in the dexpanthenol group (4.8%)
entered the phase with no skin changes. The
mean (SD) nipple trauma score on the
seventh day of intervention was 0.22 (0.52),
0.19 (0.46), and 0.19 (0.50) for the lanolin,
peppermint, and dexpanthenol groups,
respectively. More than 80% of mothers
entered the phase with no skin changes on
the seventh day of intervention. The
number of mothers entering the
aforementioned stage was 34 (82.9), 34
(82.9%), and 36 (85.7%) in the lanolin,
peppermint and dexpanthenol groups,
respectively. On the fourteenth day of
intervention 100% of mothers in the three
groups showed no skin changes. No
significantly statistical difference was found
between nipple pain score in the three
groups on the third, seventh, and
fourteenth days of observation and on the
start day (P>0.05) (Table 3).
However, the results of repeated
measures ANOVA indicated a significant
decrease in each group the comparison of
the three phases (P<0.001) (Table 3).
In the research procedure all of the three
groups were asked to first apply the cream
to their forearms and administer the drug if
no sign of sensitivity to the drug was
observed after 24 hours. The patients
showed sensitivity to none of the three
drugs. No infant reaction was also observed
in the three groups to nipples coated with
the aforementioned creams. That is to say,
the infants easily started and continued
drinking breast milk. Therefore, no
difference was made to the breastfeeding
procedure and no complication was
observed. There was also no statistically
significant difference between the groups in
terms of side effects when taking creams.
Discussion
Research results revealed the equivalent
effects of the 0.2% peppermint, lanolin, and
Effects of herbal drugs on treatment of traumatic nipples
Journal of Caring Sciences, December 2015; 4 (4), 297-307 |303
Table 1. Comparison of social-personal and obstetric profiles of patients in the lanolin,
peppermint and dexpanthenol groups
Personal information
Lanolin
Peppermint
Dexpanthenol
P
Age (years)
15-29
25 (61)
73 (2.30)
61 (0.25)
0.505*
30-39
13 (31.7)
11 (26.8)
15 (36.6)
40
0 (0)
1 (2.4)
Mean (SD)
27.7 (8.6)
27 (6.1)
27.2 (5.9)
0.974
First marriage age
< 25
36 (85.7)
37 (90.2)
32 (76.2)
0.334*
25
6 (14.3)
4 (9.8)
10 (23.8)
Mean (SD)
19.8 (4.4)
20.4 (3.5)
21.6 (4.2)
0.226
Education
Primary school
8 (19)
12(29.3)
15 (37.5)
Secondary school
8 (19)
4 (9.8)
5 (12.5)
0.207§
High school
13 (31)
10 (24.4)
9 (22.5)
University
13 (31)
15 (36.6)
11 (27.5)
Mother’s job
Housewife
39 (94.7)
42 (100)
36 (92.3)
0.232*
Employed
3 (5.3)
-
6 (7.7)
Family income
Equal income and expenses
34 (81)
34 (81)
33 (78.6)
0.732*
Income higher than expenses
8 (19)
8 (19)
8 (19)
Income lower than expenses
-
-
1 (2.4)
Infant gender
Female
22 (52.4)
20 (47.6)
19 (45.2)
0.671*
Male
20 (47.6)
22 (52.4)
22 (52.4)
Number of pregnancies
1
28 (66.7)
24 (57.1)
21 (50)
0.180*
2
6 (14.3)
11 (26.2)
11 (26.2)
3≥
8 (19)
7 (16.7)
10(23.8)
Number of deliveries
1
27 (65.9)
28 (68.3)
18 (47.4)
0.048*
2
8 (19.5)
12 ( 29.3)
10 (26.3)
3≥
6 (14.6)
1 (2.4)
10 (26.3)
Number of children
1
13 (65.5)
14 (70)
14 (58.3)
0.251*
2≥
7 (35)
6 (30)
10(41.7)
Mode of delivery
Natural
32 (80)
38 (90.5)
35 (83.3)
0.200*
C-section
8 (20)
4 (9.5)
7 (16.7)
History of surgery
Yes
6 (17.6)
3 (7.5)
1 (2.6)
0.055*
No
28 (82.4)
37 (92.5)
37 (97.4)
All of the figures, except for the specified figures, are expressed as frequency (%).*Chi-square test; One-way analysis of variance (ANOVA), §
two-tailed Chi square test
Shahnazi et al.
304 | Journal of Caring Sciences, December 2015; 4 (4), 297-307
Table 2. Comparison of mean (SD) score of pain in four time periods for the lanolin,
peppermint, and dexpanthenol groups
Groups
Prior to intervention
3rd day
7th day
14th day
P
Lanolin
3.12( 093)
1.29 (0.60)
0.24 (0.49)
0
< 0.001
Peppermint
3.05 (1.02)
1.26 (0.54)
0.22 (0.47)
0
< 0.001
Dexpanthenol
3.07 (1.02)
1.33 (065)
0.14 (0.42)
0
< 0.001
P*
0.861
0.861
0.589
ANOVA with Repeated Measure, *ANOVA
Table 3. Comparison of trauma score in four time periods in the lanolin, peppermint and
dexpanthenol groups
Groups
Before treatment
3rd day
7th day
14th day
P
Lanolin
3.41 (0.89)
2.00 (0.52)
0.22 (0.52)
0
< 0.001
Peppermint
3.36 (0.89)
2.09 (0.73)
0.19 (0.46)
0
< 0.001
Dexpanthenol
3.36 (1.10)
1.88 (0.77)
0.19 (0.50)
0
< 0.001
P*
0.920
0.4
0.954
ANOVA with Repeated Measure, *ANOVA
dexpanthenol creams on the treatment of
nipple pain and trauma. A thin layer of
these creams was administered every 8
hours for two weeks. In the present study,
according to the Store scale, the pain of
participants in the lanolin group declined
by 0%, 78%, and 100% on the third, seventh,
and fourteenth days of intervention,
respectively. Moreover, 2.4%, 80.5%, and
100% of reduction were observed in the
peppermint group in the aforementioned
days and 2.4%, 88.1%, and 100% of decline
were observed in the dexpanthenol group,
respectively. The results of the research by
Dennis et al., were in line with the results of
our study regarding the effectiveness of
lanolin.9 In the study by Abou-Dakn et al.,
80% decline was observed on the seventh
day and full recovery was obtained on the
fourteenth day.10 These findings are also
consistent with our findings, but in their
research the effect of peppermint water on
the treatment of nipple pain was reported to
be more than lanolin cream. Therefore, their
study does not comply with our study in
general and the difference in the results was
resulted from the fully uniform intervention
in our study. Moreover, in their research the
groups were not equally exposed to
intervention, because 100 patients in the
lanolin group, 50 patients in the teabag
group, and 50 patients in the peppermint
group were undergone the intervention.
In the present study, according to the
Champion scale, similar levels of
improvement in term of nipple trauma
resulted from administration of the
peppermint, lanolin and dexpanthenol
creams. In a study conducted by KuScu et
al., the results of using dexpanthenol for the
treatment and recovery of trauma were
similar to our results. That is to say,
dexpanthenol contributes to the healing of
skin wounds through epithelialization and
granulation. It also leads to wound
improvement by storing water through the
epidermis.17 In the research by Dennis et al.,
the patients were mainly complaining about
pain and 78% and 71% of pain declines
were observed in the multipurpose
ointment and lanolin groups on the seventh
day of treatment, respectively.9
The results of their study are consistent
with our study regarding the decreased
pain symptoms. Vieira et al., conducted a
systematic review and concluded that
administration of lanolin with or without
breast milk was the most effective
intervention for the treatment of traumatic
nipples as compared with other the
Effects of herbal drugs on treatment of traumatic nipples
Journal of Caring Sciences, December 2015; 4 (4), 297-307 |305
treatments such as breast milk, hydrogel,
adhesive polyethylene film dressings, a
spray containing chlorhexidine with
alcohol, and distilled water.21 In the other
study by Mohammadzadeh et al., the
duration of trauma recovery in the lanolin
group was higher than the breast milk and
control groups. Their study was not in line
with our research. The reason for the
difference between our results and the
above research was the limitations that
were found on this research.22
For example, no scale was used to
determine the scores for nipple trauma
andthe ranking was carried out under the
supervision of a researcher, who was aware
of the study groups. Therefore, nipple
trauma was assessed with more precision in
our study.
One of the advantages of this study was the
innovation in using 0.2% peppermint
essence in the form of cream for the
treatment of traumatic nipples. Moreover,
the recovery of patients on the 3rd, 7th, and
14th days of treatment was also followed.
Since no pre-term and abnormal infants
were included in the study, the research
findings cannot be generalized to these
infants. Moreover, this research was not
carried out in medical centers of villages,
and other cities. Therefore, the trainings, the
program resulted from the native
specifications of Sanandaj City, and its
results may not be applicable to other areas
and cities of Iran.
The following recommendations are
provided for future studies in this field.
1. Since few studies have been conducted
in Iran and the world on traumatic nipple
treatment, it is recommended to carry out
further studies on this topic. Moreover,
Iranian studies have solely focused on
prevention of trauma.
2. It is recommended to conduct studies on
the possible maternal and neonatal side
effects of substances used for traumatic
nipple treatment.
Conclusion
The contribution of peppermint to the
treatment of traumatic nipples is similar to
that of lanolin and dexpanthenol. Therefore,
peppermint could be considered as an
effective alternative to the treatment of
traumatic nipples in patients willing to use
herbal medicines.
Acknowledgments
Hereby we express our gratitude to the
personnel of Bessat Hospital, Abbas Abad
and Farabi clinics in Sanandaj, and the
Laboratory of Pharmaceutics of Tabriz
School of Pharmacy who assisted us in
preparing the medicines. We also would
like to thank the authorities of the School of
Nursing and Midwifery and research
deputy of Tabriz University of Medical
Sciences for their financial support and also
other colleagues who aided us in the course
of this research.
Ethical issues
None to be declared.
Conflict of interest
The authors declare no conflict of interest in
this study.
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