Human milk – as a topical treatment?

Not too long ago, a participant in one of my research studies asked me if I had heard of using breast milk as a treatment for ear or eye infections and skin rashes. A friend had recommended treating a recent episode of conjunctivitis on the baby with human milk. About a year earlier, another participate had informed me that she was putting milk in her baby’s ear to treat an infection.  So here’s the question . . .does it actually work?

Figure 1: Much like Gus Portokalos found that Windex cured everything, is it possible that human milk can treat topical infections?

Ear Infections

First off, there is good evidence that the act of breastfeeding reduces the risk of ear infections in infants. It is unclear if this benefit is related to the milk itself or to the actual act of suckling at the breast, as no studies have been conducted on infants receiving only pumped milk. Abraham and Labbock do hypothesize that the mechanical act of suckling, with its distinct pattern of suck, swallow, breathe and the may increase aeration of the eustachian tube, while the differences in pressure associated with bottle feeding may instead increase the risk of eustachian tube dysfunction from the negative pressure transmitted from the bottle (Brown and Magnuson 2000). Importantly, these pressure differences are only found in unventilated or partially ventilated bottles – fully ventilated bottles showed no such pressure changes. Human milk also contains numerous antibodies and immune factors that will serve to protect the infant from infection.

However, the use of breast milk as a topical treatment for ear infections has not been similarly studies. No one has ever published the results of a randomized control trial – or even an observational study – on the topical application of human milk as a treatment for ear infections. And there is a pretty good reason why:

Most ear infections clear up on their own without the need for further treatment.

In fact, the American Academy of Pediatrics recommends against using routine antibiotics in the case of milk to moderate ear infections, instead reserving them for severe or chronic infections. Further, the majority of ear infections are middle ear infections, on the inside of the ear drum. In this instance, the ear drum will block the milk from entering the ear and maintain a barrier between the milk and the infection.  The majority of personal accounts reporting breast milk as curing the ear infection? The mostly likely explanation is that the ear infections resolved from a combination of immunological support from the mother’s milk during normal breastfeeding practices and the infant’s immune system, not from the external application of the milk.  

Skin conditions: rashes, eczema

Okay, so what about breast milk as a treatment for other, topical conditions, such as skin rashes, eczema, or diaper rash? In these instances, the milk will be in direct contact with the infection, possibly allowing the immunological agents in the milk to work directly on the infection. And certainly, we know from studies exposing different pathogens to human milk that exposure is associated with increased pathogen death.

A recent study by Farahani, Ghobadzadeh, and Yousefi actually conducted a randomized clinical trial or hydrocortisone 1% ointment compared to freshly expressed human milk in study of 141 breastfeeding infants. All infants in the study were breastfeeding, and they were randomly assigned to one of the two treatment groups: freshly expressed human milk or topical application of the 1% hydrocortisone ointment. Treatment lasted for 7 days, with clinical assessment of the diaper rash at baseline, 3 and 7 days. There were no differences between the two groups with regards to severity scoring of the rash at recruitment and no difference in severity between the two groups at day 7. Most importantly, both groups had shown significant declines in severity from the baseline assessment.  So, for mild diaper rash, human milk applied a minimum of three times a day has been shown to reduce severity of diaper rash. 

Eye infections

The history of using human milk as a treatment for eye infections is a very old one, going back to some of the earliest known medical texts. However, not much is known about the effectiveness. A recent study by Baynham and colleagues (2013) looked at the effectiveness of fresh human milk against several species of bacteria that commonly cause eye infections in infants. The researchers tested milk against Escherichia coli, Haemophilus influenzae, Neisseria gonorrhoeae, Pseudomonas aeruginosa, Streptococcus pneumonia, Staphylococcus aureus, Moraxella catarrhalis, coagulase-negative Staphylococcus and viridans group Streptococcus. Of these bacteria, three were inhibited following exposure to human milk: three were significantly inhibited by human milk relative to the negative control: N. gonorrhoeae, M. catarrhalis and viridans group Streptococcus. Human milk was as effective as polymyxin B sulfate/trimethoprim ophthalmic solutions against N. gonorrhoeae; less so but still effective against M. catarrhalis and Streptococcus.  In the typical American infant, the common causes of conjunctivitis are H influenzae, Streptococcus pneumonia and M catarrhalis. However, this pattern is unique to developed countries – in developing countries the most common pathogen causing eye infections is N. gonorrhoeae.

So how does human milk stack up as a topical treatment? Pretty well based on the limited clinical evidence and there is certainly no data to suggest that using milk as a first line intervention will have any negative consequences. 

References

Abrahams, Sheryl W., and Miriam H. Labbok. “Breastfeeding and Otitis Media: A Review of Recent Evidence.” Current Allergy and Asthma Reports 11, no. 6 (August 11, 2011): 508. doi:10.1007/s11882-011-0218-3.

Baynham, Justin T. L., M. Allison Moorman, Catherine Donnellan, Vicky Cevallos, and Jeremy D. Keenan. “Antibacterial Effect of Human Milk for Common Causes of Paediatric Conjunctivitis.” The British Journal of Ophthalmology 97, no. 3 (March 2013): 377–79. doi:10.1136/bjophthalmol-2012-302833.

Brown, C. E., and B. Magnuson. “On the Physics of the Infant Feeding Bottle and Middle Ear Sequela: Ear Disease in Infants Can Be Associated with Bottle Feeding.” International Journal of Pediatric Otorhinolaryngology 54, no. 1 (August 11, 2000): 13–20.

Farahani, Leila Amiri, Maryam Ghobadzadeh, and Parsa Yousefi. “Comparison of the Effect of Human Milk and Topical Hydrocortisone 1% on Diaper Dermatitis.” Pediatric Dermatology 30, no. 6 (December 2013): 725–29. doi:10.1111/pde.12118.

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