It's unusual for something this specific to be posted in a mainstream
pediatric journal IMO :)
Raynaud's Phenomenon of the Nipple May Cause Painful Breastfeeding
Laurie Barclay, MD
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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