Raynaud's Phenomenon of the Nipple May Cause Painful Breastfeeding

Laurie Barclay, MD

April 09, 2004

April 9, 2004 — Raynaud's phenomenon of the nipple is a treatable cause of painful breastfeeding, according to a series of 12 cases reported in the April issue of Pediatrics.

"Raynaud's phenomenon is now felt to be common, affecting up to 20% of women of childbearing age," write Jane E. Anderson, MD, from the University of California at San Francisco, and colleagues. "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."

This case series consists of 12 women who breastfed 14 infants. All were seen in one pediatric practice and one lactation consultation center in San Francisco, California, within the past three years, and 11 women were seen between June 2002 and May 2003.

Breastfeeding was extremely painful in all women, with symptoms brought on by cold temperatures and associated with nipple blanching followed by cyanosis and/or erythema. Six of the 12 mothers had experienced similar symptoms during pregnancy, and three mothers reported a history of breast surgery.

Experienced lactation counselors evaluated 10 of the 12 mothers and determined that these symptoms were not due to inappropriate breastfeeding techniques. Before the correct diagnosis was made, eight of the 12 mothers and their infants received multiple courses of antifungal therapy for presumed Candida albicans infection without relief.

"Treatment options include methods to prevent or decrease cold exposure, avoidance of vasoconstrictive drugs/nicotine that could precipitate symptoms, and pharmacologic measures," the authors write. "Because most women with painful breastfeeding require immediate relief of the pain to continue breastfeeding successfully, it is important to offer a treatment plan that will alleviate the pain quickly."

The authors recommend nifedipine, a calcium channel blocker and vasodilator used to treat Raynaud's phenomenon, because it is effective and because very little of the medication can be found in breast milk.

All six mothers who chose to use nifedipine had prompt relief of pain, and one mother developed adverse effects. Other treatment options include aerobic exercise, biofeedback, calcium and magnesium supplementation, and use of evening primrose oil and fish oil.

"Pediatricians and lactation consultants should be aware of this treatable cause of painful breastfeeding and should specifically question their patients, because most mothers will not provide this information to the breastfeeding consultant," the authors write. "Prompt treatment will allow mothers to continue to breastfeed pain-free while avoiding unnecessary antifungal therapy."

Pediatrics. 2004;113:e360-e364

Reviewed by Gary D. Vogin, MD

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