Topical Treatment With Fresh Human Milk Versus Emollient on Atopic Eczema Spots in Young Children

A Small, Randomized, Split Body, Controlled, Blinded Pilot Study

Teresa Løvold Berents; Jørgen Rønnevig; Elisabeth Søyland; Peter Gaustad; Gro Nylander; Beate Fossum Løland

Disclosures

BMC Dermatol. 2015;15(7) 

In This Article

Discussion

In this small, split body controlled randomized pilot study of human milk and emollient applied topically on eczema spots in six children, no effect was found on eczema spots treated with the topical application of fresh human milk. In two of five children with persistent eczema lesions during the study, there was less involvement of the human milk treated area compared to the emollient area at study end compared to baseline. However, the opposite was found in three children.

There are few studies looking at the effect of human milk on eczema. One study of children with diaper dermatitis examined the effect of applying human milk after each breastfeeding or hydrocortisone 1% ointment twice a day, detecting after one week an effect of human milk comparable to that of hydrocortisone.[9] The application frequency was higher than in our study, but we still believe that an application rate of three times a day would be enough to show an effect of human milk, after four weeks of treatment.

There are many theoretical indications of how human milk can be effective on eczema lesions. One aspect of atopic disease is the type 2 helper T cell (Th2) dysbalance with production of interleukin- 4 (IL-4), IL-5, and IL-13 in the acute phase. In the chronic phase there is a Th1/Th0 dominance with production of interferon-γ, IL-2, IL-5 and granulocyte-macrophage colony-stimulating factor.[2] Of interest, therefore, are findings from an animal model, where the effect of human colostrum used locally on an acute inflammatory process was shown to be as potent as oral indomethacin and superior to oral dexamethasone at suppressing polymorphonuclear leukocyte influx.[14,15] In humans, the milk contains, among a wide variety of biologically active hormones, glucocorticoids. These are transferred from plasma to the milk in levels fairly highly correlated (in the .6-.7 range).[16]

Milk samples from healthy donors have revealed bacteria in 10–23% of the samples.[17] In the present study, bacteria were found in three of 28 samples; 11%. In one child only (child number five), S. aureus was found once in both the eczema spot and in the milk. Clinically, however, the eczema was not infected, and this child had S. aureus on both eczema lesions at every visit. This suggests that no iatrogenic infections due to application of fresh mothers milk occurred. Surprisingly, S. aureus was found in the intervention area but not in the control area on four occasions in three different children. One speculation might be that the preservative (eg. phenoxyethanol) in the emollient had some antimicrobial effect when applied alone.

Human milk contains several different substances that act against bacteria, virus and fungi, such as Secretory IgA and Secretory IgM,[18] lactoferrin, lysozyme, oligosaccharides, Toll-like receptors and fatty acids.[8] In a study evaluating the inhibition in vitro of human colostrum against bacterial cultures from eye swabs of neonates with neonatal conjunctivitis, the inhibitory activity was ≥ 50% against S. aureus and coliform bacteria, demonstrating an antimicrobial effect also in vitro.[19] A consistent inhibitory effect of human milk was found against Neisseria gonorrhea in children with conjunctivitis. A significant but less pronounced effect was also found against Moraxella catarrhalis.[10] This strengthens the evidence for an antimicrobial effect of human milk also when used topically. When comparing different methods for preventing omphalitis in newborns, an application frequency of topical human milk twice a day demonstrated a shorter separation time of the umbilical stump compared to the use of antiseptics.[20] In the study of Ibhanesebhor,[19] the mean duration of inhibition of human milk against S. aureus was three hours. Considering the huge amount of different biologically active components and cells in human milk, there might be a variety of candidates for explaining the positive effects described above.

The children participating in the present study were recruited through advertisement posters in well baby clinics, and responding mothers were presumably highly motivated and inclined to trust alternative/new treatment methods. We cannot rule out that the mothers co-treated the intervention sites with for instance steroid cream, but the instructions with respect to treatment of the intervention and control site were clear, and the results do not indicate performance bias.

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