Nipple pain: Raynaud's beyond fingers and toes

Abstract

Raynaud's phenomenon of the nipple (RPN) is a cause of nipple pain scarcely reported in the literature and frequently missed by physicians. We present a case of RPN in a pregnant mother who sought breast surgical consultation for episodic nipple pain. Review of the literature reveals RPN is predominant in lactating and pregnant patients and missed diagnosis can cause cessation of breastfeeding or mistreatment with antifungals. Clinical suspicion should be raised if symptoms are precipitated by cold, associated with color change, occur during pregnancy or breastfeeding, or with a history of Raynaud's. Treatment is generally supportive, with nifedipine used for severe cases.

Identifying the cause of breast and nipple pain during lactation

“…A sensitivity to cold (the woman might describe “poor circulation”) or history of Raynaud’s disease in herself or family, could suggest nipple vasospasm (Raynaud’s phenomenon of the nipple) as a primary cause or contributing factor to her pain 22…”

“…The nipple tip may turn white when exposed to the cold, indicating nipple vasospasm. It is more common for the vasospasm to be caused by a tendency to poor circulation22; however, Raynaud’s disease might be causing the pain…”

“…In nipple vasospasm, the nipple tip, or part of the nipple tip, turns white shortly after the feed and is associated with throbbing pain; mothers who hold breast in their hand may be warming the nipple to reduce pain. In classic Raynaud’s phenomenon of the nipple, the nipple tip turns white, followed by blue or red and blue, ie, biphasic or triphasic colour changes 22…”

Common Complications of Breastfeeding and Lactation: An Overview for Clinicians

“…Between episodes the breast exam will be entirely normal, thus excluding dermatoses of the nipple. Individuals who experience Raynaud’s Phenomenon of the nipple may have a personal or family history of Raynaud’s Phenomenon, a history of nipple trauma or injury with breastfeeding, a history of prior breast surgery, or be experiencing excessive stress 53…”

“…Individuals who experience Raynaud's Phenomenon of the nipple may have a personal or family history of Raynaud's Phenomenon, a history of nipple trauma or injury with breastfeeding, a history of prior breast surgery, or be experiencing excessive stress. 53 The treatment of Raynaud's Phenomenon includes optimization of infant latch and breastfeeding techniques to avoid exacerbation with trauma. Application of warm compresses, avoidance of stressful triggers, caffeine and stimulant medications is recommended.…”