Raynaud’s Phenomenon of the Nipple: A Treatable Cause of Painful Breastfeeding

Abstract

ABSTRACT. Maurice Raynaud first described the vasospasm of arterioles in 1862, and Raynaud's phenomenon is now felt to be common, affecting up to 20% of women of childbearing age. Raynaud's phenomenon has been reported to affect the nipples of breastfeeding mothers and is recognized by many lactation experts as a treatable cause of painful breastfeeding. In 1997, LawlorSmith and Lawlor-Smith reported 5 women with Raynaud's phenomenon associated with breastfeeding, but there are few other case reports, and none report the possible relationship between Raynaud's phenomenon of the nipple and previous breast surgery.We report 12 women who breastfed 14 infants, all of whom were seen in 1 pediatric practice and 1 lactation consultation center in San Francisco, California, within the past 3 years. Of the 12 women, 11 were seen between June 2002 and May 2003. All women suffered from extremely painful breastfeeding, with symptoms precipitated by cold temperatures and associated with blanching of the nipple followed by cyanosis and/or erythema. Poor positioning and poor attachment or latch may cause blanching of the nipple and pain during breastfeeding, but 10 of the 12 mothers were evaluated by experienced lactation consultations, who were sure that inappropriate breastfeeding techniques were not contributing factors.Because the breast pain associated with Raynaud's phenomenon is so severe and throbbing, it is often mistaken for Candida albicans infection. It is not unusual for mothers who have Raynaud's phenomenon of the nipple to be treated inappropriately and often repeatedly for C albicans infections with topical or systemic antifungal agents. Eight of our 12 mothers and their infants received multiple courses of antifungal therapy without relief before the diagnosis was made.To diagnose Raynaud's phenomenon accurately, additional symptoms such as precipitation by cold stimulus, occurrence of symptoms during pregnancy or when not breastfeeding, and biphasic or triphasic color changes must be present. All our mothers experienced precipitation of symptoms by cold stimuli and demonstrated biphasic or triphasic color changes, and 6 of the 12 experienced symptoms during pregnancy.Interestingly 3 of 12 mothers also reported a history of breast surgery, including 1 mother who had a fibroadenoma removed and 2 who had breast-reduction surgery. The association between breast surgery/implants and autoimmune disease, including Raynaud's phenomenon, has been discussed extensively, but the association of Raynaud's phenomenon of the nipple during breastfeeding has not been reported previously. Given the small numbers in the study, it is uncertain as to whether this may be a precipitating factor in developing Raynaud's phenomenon.Treatment options include methods to prevent or decrease cold exposure, avoidance of vasoconstrictive drugs/nicotine that could precipitate symptoms, and pharmacologic measures. There are reports in the lay press of the use of herbal medicines, aerobic exercise, and dietary supplements, but because most wom...

Conquering Common Breast-feeding Problems

“…If these efforts fall short, nifedipine-a calciumchannel blocker with vasodilating effects, has successfully been used to treat this condition. 26 This drug is usually compatible with breast-feeding, and only small amounts are measurable in breast milk. 27 • Fungal overgrowth and infection with C. albicans can be a source of intense, persistent, and prolonged nipple and breast pain.…”

Enabling Women to Achieve Their Breastfeeding Goals

“…In women with partial relief with heat, extendedrelease nifedipine can markedly improve symptoms. 65 Severe, shooting, burning pain unresponsive to heat or nifedipine may present as part of a functional pain syndrome. Patients with this condition may report a history of other pain disorders such as migraines, irritable bowel syndrome, dysmenorrhea, or dyspareunia.…”

Fenómeno de Raynaud y el amamantamienteo doloroso

“…El fenómeno de Raynaud del pezón fue descrito por primera vez en 1970 en EEUU, afectando al 20% de las mujeres en edad fértil 3 . Se ha asociado a diversas enfermedades endocrinas y reumatológicas, así como al uso de tóxicos y medicaciones.…”

“…Aunque el vasoespasmo suele estar provocado por la exposición al frío, se han descrito otros precipitantes como el estrés emocional 1,3 .…”

“…Este cambio de coloración suele ser trifásico (blanco, azulado y rojo), aunque en ocasiones puede ser bifásico (de blanco a azul). El dolor empeora con el frío y mejora con el calor, y puede acompañarse de grietas, ampollas o úlceras 3 . Puede asociarse a lesión del tipo de la esclerodermia 4 .…”