Article

Raynaud phenomenon of the nipple in breastfeeding mothers: an underdiagnosed cause of nipple pain.

University of Southern California, Keck School of Medicine, Los Angeles, CA, USA.
JAMA dermatology (Chicago, Ill.) 03/2013; 149(3):300-6.
Source: PubMed

ABSTRACT To elucidate the diagnostic criteria of Raynaud phenomenon of the nipple that will aid in recognizing and treating Raynaud phenomenon in breast feeding mothers with chronic deep nipple pain during lactation.
Retrospective review of a patient database composed of 22 cases of breastfeeding mothers who fit the diagnostic criteria for Raynaud phenomenon of the nipple.
Menlo Dermatology Medical Group in Menlo Park, California, an academic-affiliated, private dermatologic referral center.
All patients diagnosed as having Raynaud phenomenon of the nipple evaluated from January 1, 2004,through December 31, 2010.
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.
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.
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.

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    ABSTRACT: Abstract Background: Although breast pain remains a common cause of weaning, controversy exists regarding the etiology of chronic pain. Prospective studies are needed to define optimal treatment regimens. We evaluated patient history, exam, and bacterial cultures in breastfeeding women with chronic breast pain. We compared pain resolution and breastfeeding complications in patients responding to conservative therapy (CTX) (n=38) versus those in patients failing CTX and receiving oral antibiotic treatment (OTX) (n=48). Subjects and Methods: We prospectively enrolled 86 breastfeeding women with breast pain lasting greater than 1 week and followed up patients through 12 weeks. Results: Higher initial breast (p=0.012) and nipple pain severity (p=0.004), less response to latch correction (p=0.015) at baseline visit, and breastmilk Staphylococcus aureus growth (p=0.001) were associated with failing CTX. Pain type was not associated with failure of CTX. When culture results were available at 5 days, breast pain remained higher (p<0.001) in patients failing CTX and starting antibiotics. OTX patients then had more rapid breast pain reduction between 5 and 14 days (score of 3.1 vs. 1.3; p<0.001). By 4 weeks there was no difference (1.8/10 vs. 1.4/10; p=0.088) in breast pain level between groups. Median length of OTX was 14 days. At 12 weeks, weaning frequency (17% vs. 8%; p=0.331) was not statistically different. Conclusions: Initial pain severity and limited improvement to latch correction predicts failure of CTX. S. aureus growth is more common in women failing CTX. For those women not responding to CTX, OTX matched to breastmilk culture may significantly decrease their pain and is not associated with increased complications.
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