Thursday, July 30, 2009

Raynaud’s Phenomenon of the Nipple

This article would have been off my radar had it not been for the interaction on twitter.

jeffreyleow RT @paulinechen: Camera Phones [patients taking pics] helps doctor make rare diagnosis http://3.ly/CXr (via @EllenRichter)

Granted I am not generally asked about nipple pain in pregnant women.  Those questions tend to go to folk like TBTAM or ER’s Mom

The article describes a case report of a 25 yo woman in her 2nd trimester with “frequent episodes of extreme bilateral nipple pain. A typical episode lasted between 5 and 15 minutes and was so painful as to bring her to tears.”

The article discusses Raynaud’s phenomenon of the nipple and share these photos (credit) taken with a camera phone with us.  The text with the photo:

Vasospasm of the arterioles manifesting as pallor (left), followed by cyanosis, and then erythema (centre). The right hand image shows the normal, asymptomatic, status.

 

As with Raynaud's of the hand (which I am more familiar with), the phenomenon tends to occur when the ambient temperature drops below a certain threshold that is specific to each individual.  Exposure to cold should be avoided, as is avoidance of caffeine, nasal vasoconstrictors, and tobacco.

Additional treatment for Raynaud’s of the nipple:

Women with persistent pain require immediate relief to continue breastfeeding successfully. Recommended treatment is 30 mg nifedipine of sustained-release once-daily formulation, and most women respond within two weeks.

 

 

REFERENCE

An Underdiagnosed Cause of Nipple Pain Presented on a Camera Phone; BMJ 2009;339:b2553; O L Holmen, B Backe

Vasospasm of the Nipple–a manifestation of Raynaud's phenomenon: case reports; BMJ 1997 314: 644; Laureen Lawlor-Smith and Carolyn Lawlor-Smith

 

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13 comments:

Dreaming again said...

Raynauds of the hand (and feet) is bad enough ..this would be absolute torture!!!

ER's Mom said...

Interesting, I've never heard of Reynauds of the nipple.

Something to keep in the back of my head...

Anonymous said...

I have seen this in my OB practice and the nifedipine worked very well.

drcharles said...

who knew? makes sense, I guess, not sure I'll ever make this diagnosis!

Teresa said...

I'm a 32 year old woman who has suffered with this since I was 11 I live in Minnesota and there is no escape from the cold here. Last night I finally found on the internet someone else who suffers from this, but only when she's pregnant. This is the most painful thing. I've seen dermatologists, breast doctors, gynocologists,and had a mammogram done last week trying to figure this out. that doctor told me I needed to see my psychiatrist about the pain!! I have even been tempted to see a plastic surgeon about having them removed. It is excruciating like having them bitten hard and they won't let go. My god the torture

Anonymous said...

I have experienced this phenomenon for over 13 years. 13 years ago, at the age of 26 I had a mammogram to determine the cause of this excruciating pain and my nipple turning white. At that time I was told to wear a sweater. Recently, my PCP told me what she thought it was and suggested I cut down on caffeine. She also suggested nitroglycerin but that's not an option for me because I have very low blood pressure. It's nice to know I am not the only one. And to tell people it doesn't just happen to women that are pregnant or nursing...

Anonymous said...

I suffer from this - it is very real!
I am not pregnant but started getting it around my first pregnancy seven years ago.
I was at the time diagnosed with a liver tumour and believe the raynaud's can be secondary to some illnesses.
It's snowing here in the Uk and my right nipple is very sore despite multi layers!

Anonymous said...

I have had this problem for about three years. The pain is indescribable. I do not have children, so no breastfeeding here. It has been getting worse each winter, and leaves my entire breasts sore after an episode. The triphasic colors I experience are much brighter than the pictures shown here, but that may be the quality of photos coming from a phone. My doctor prescribed nifedipine today, and I'm hoping for success. Any other suggestions for remedies, please post!

Anonymous said...

you mean I'm not alone in this one??? That's good to know because it is scary...
My nipples get EXTREMELY Painful and it lasts past the warm up for about 15-30 minutes. I have no children, so not breastfeeding or anything. I'm 31 years old and this just started happening to me this year, which seems strange because I'm now living in a warmer climate.
I don't have to worry about being pregnant or anything??? Almost all the posts are from women who have had a least 1 kid - - - that is SO not for me.

Anonymous said...

I am so glad I came across this. I never experienced this until I was pregnant. It started then and my son is 2 now but I still have "episodes" every now and then. I actually never told my doctor because I thought I was an odd case and he would think I was crazy. The pain literally brings tears to my eyes, it is very real. It all started on our honeymoon. I was 3 months pregnant, we went swimming and when I got out and was cold the first pains crept in. I was close to going to ER it hurt so bad but after 20-25 minutes it subsided. I'm so thankful I found this info, now I don't feel crazy!

Nascar Hottie said...

Thank you for this blog! My 2nd child is now 9 weeks old and I had no idea that this crazy burning stabbing pain actually had a name! I was diagnosed yesterday after seeing THREE lactation Specialists & I have started the nifidipene last night. My "episodes" dont come with the breastfeeding-thye hit atthe strangest moments...but Ive noticed that cold definately makes it worse. Hopefully the meds work!

Anonymous said...

I started getting this almost 8 years ago with my 4th pregnancy.The midwife told me it would stop after breast feeding.Well 8 years on and I still have episodes. I find a warm shower helps and then layer on the clothing.

Laura said...

I got to this page because I am experiencing Raynauds of the right nipple. It is only the right nipple at this point, and I am in no way pregnant or even close to having given birth. My "baby" is 18. I did have breast reduction surgery twice in 2010 but had no problems until the last 2 months. I have Raynauds of my hands and feet. I also have an autoimmune disease, Psoriatic Arthritis. This is the most painful thing that I have experienced. I wish I knew what to do about it. 2 more weeks until I can see my Rheumatologist and ask him.