2015 To the Editor: Re. “Review on emu products for use as complementary and alternative medicine”

Re. “Review on emu products for use as complementary and alternative medicine” 2015

Vincenzo Zanardo, M.D.
David Giarrizzo, M.D.
To the Editor:
We read with great interest the review by Jeengar et al. who summarized recent findings published in the literature concerning the oral or topical use of emu oil [1]. Containing high quantities of polyunsaturated fatty acids and antioxidants [2], emu oil seems to have potent anti-inflammatory effects [3]. Its mechanisms of action are, however, not entirely clear and have not, until now, been extensively studied. Some investigators have recently suggested that it can be used to prevent damage to the tender breasts of new mothers [4].

When newborns latch on to the breast, mothers often experience pain, which is caused by the nipple and areola being pulled into the baby’s mouth. The first days after birth are often characterized by breast discomfort due to rough treatment of the tender area and other causes such as engorgement or dryness. Sore, cracked nipples are, in fact, a common problem during the early days of breastfeeding, with an incidence ranging from 11% to 96% [1]. The pain can even be so severe as to lead to premature weaning [5]. Additionally, traumatized nipples, exposed not only to maternal skin flora but also to the infant’s oral flora, readily become superinfected with bacteria or yeast that themselves can delay or impede healing [5].

Recently, we found that when breastfeeding mothers used an emu oil–based cream for a 24-h period beginning quite soon after delivery, the cream was effective in improving the hydration of the stratum corneum of the breast areola and nipple (from 56.9 ± 18.1% to 65 ± 17.7%; P < 0.002). The improvement found in hydration was more pronounced in the puerperae presenting with basal hydration in the lower quartiles from 41.6 ± 9.5 to 59.6 ± 8.7%; P < 0.001. The cream did not affect the pH, temperature, or elasticity of breast areola.

This unexpected finding could be linked to a number of factors. Skin barrier function depends on several variables including the level of hydration; the cellular properties of corneocytes; the association of these cells in the stratum corneum; the turnover, amount, and composition of the intercellular lipids; and the skin surface pH [6]. The water content of the stratum corneum and surface lipids form a balance that is quite important for the normal function and integrity of the breast skin barrier [6].

A variety of treatments have been used to prevent or to treat nipple trauma or pain associated with breastfeeding. These include topical creams, solutions or sprays, time-restricted breastfeeding, exposure of the nipples to dry heat or ultraviolet light and air drying, hardening of the nipple skin, and pre- or postnatal breastfeeding education. However, there is little evidence from previous trials regarding the compliance with areola and nipple skin hydration, a key factor for skin barrier integrity.

We conclude that the current recommendation for any topical prevention or treatment of sore nipples during breastfeeding should be revised in favor of tested remedies. According to Jeengar et al., it goes without saying that more in vitro and clinical studies are warranted to investigate the mechanisms of action in emu oil topical treatment.

Information for the good of the many…