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March 2013

Raynaud Phenomenon of the Nipple in Breastfeeding Mothers: An Underdiagnosed Cause of Nipple Pain

Author Affiliations

Author Affiliations: University of Southern California, Keck School of Medicine, Los Angeles (Ms Barrett); Transitional Year Medicine Program, Harbor-UCLA, Torrance, California (Dr Heller); Department of Dermatology, Emory University, Atlanta, Georgia (Dr Heller); Menlo Dermatology Medical Group, Menlo Park, and Department of Dermatology, Stanford University Medical Center, Stanford, California (Dr Fullerton Stone); and Departments of Dermatology, Palo Alto Foundation Medical Group, Mountain View, and University of California, San Francisco (Dr Murase).

JAMA Dermatol. 2013;149(3):300-306. doi:10.1001/jamadermatol.2013.1560

Objective To elucidate the diagnostic criteria of Raynaud phenomenon of the nipple that will aid in recognizing and treating Raynaud phenomenon in breastfeeding mothers with chronic deep nipple pain during lactation.

Design Retrospective review of a patient database composed of 22 cases of breastfeeding mothers who fit the diagnostic criteria for Raynaud phenomenon of the nipple.

Setting Menlo Dermatology Medical Group in Menlo Park, California, an academic-affiliated, private dermatologic referral center.

Patients All patients diagnosed as having Raynaud phenomenon of the nipple evaluated from January 1, 2004, through December 31, 2010.

Main Outcome Measures The rate of failed treatment for Candida mastitis, the rate of improvement of symptoms with nifedipine use, and the overall rate of improvement of symptoms with appropriate therapy involving treatment of Raynaud phenomenon.

Results Among the 22 patients with Raynaud phenomenon of the nipple, previous treatment for Candida mastitis with oral or topical antifungals was ineffective in 20 (91%). Of the 12 patients who tolerated a trial of nifedipine, 10 (83%) reported decreased or resolved nipple pain. All patients experienced marked improvement of symptoms with appropriate therapy involving treatment of Raynaud phenomenon.

Conclusions Most patients were treated with antifungals before presentation without resolution of nipple pain. Nifedipine appears to be an effective medication for the treatment of Raynaud phenomenon of the nipple. With appropriate management of Raynaud phenomenon, breastfeeding mothers demonstrated improvement of nipple pain. Raynaud phenomenon of the nipple should be considered in the differential diagnosis of nipple pain during lactation.