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Therapy for Raynaud's phenomenon of nipple reduced pain in nursing mothers

Breast-feeding mothers with Raynaud's phenomenon of the nipple demonstrated pain relief with appropriate therapy, and nifedipine was an effective medication for patients who could tolerate it, according to study results.

In a retrospective study, researchers in California reviewed 22 cases of nursing mothers (aged 26 to 43 years) diagnosed as having Raynaud's phenomenon of the nipple from 2004 through 2010. Diagnostic criteria included chronic deep breast pain (lasting 4 weeks or longer) that responded to therapy for Raynaud's phenomenon and two of the following symptoms: color changes of the nipple, especially with cold exposure, cold sensitivity or color changes of the hands or feet with cold exposure and failed therapy with oral antifungals. Failed treatment rate of Candida mastitis, improvement rate of symptoms with the vasodilator nifedipine and overall rate of symptom improvements with treatment for Raynaud's phenomenon were main outcome measures.

“Patients with Raynaud's phenomenon of the nipple are often misdiagnosed as having Candida mastitis,” the researchers reported, noting that previous treatment for Candida mastitis with topical or oral antifungals was ineffective in 91% of patients.

With treatment of Raynaud's phenomenon, patients’ symptoms markedly improved. Prescribed treatment included low- to middle-strength topical corticosteroid or alclometasone dipropionate cream applied twice daily for 2 weeks. Ninety-one percent of patients were given 400 mg oral fluconazole on day 1 and 200 mg on days 8 through 10. The women were advised to wear warm clothing, take hot showers twice daily before breast-feeding and to avoid caffeine and vasoconstrictive drugs to prevent vasospasm.

Fifteen patients (68%) were prescribed nifedipine, including 12 who tolerated treatment. Ten patients reported decreased or resolved nipple pain.

“With appropriate therapy involving treatment of Raynaud's phenomenon of the nipple, all patients experienced substantial improvement … and were able to continue breast-feeding,” the researchers concluded. “Therefore, early recognition of Raynaud's phenomenon of the nipple can help prevent premature cessation of breast-feeding due to intolerable pain so that both infant and mother can experience the … benefits of breast-feeding.”