title: Raynaud phenomenon of the nipple in breastfeeding mothers: an underdiagnosed cause of nipple pain.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Retrospective review of a patient database composed of 22 cases of breastfeeding mothers who fit the diagnostic criteria for Raynaud phenomenon of the nipple.
  
  
  METHODS
  Menlo Dermatology Medical Group in Menlo Park, California, an academic-affiliated, private dermatologic referral center.
  
  
  METHODS
  All patients diagnosed as having Raynaud phenomenon of the nipple evaluated from January 1, 2004,through December 31, 2010.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Southern California, Keck School of Medicine, Los Angeles, CA, USA.
authors.forename: Meagan E
authors.initials: ME
authors.lastname: Barrett
authors.forename: Misha M
authors.initials: MM
authors.lastname: Heller
authors.forename: Honor Fullerton
authors.initials: HF
authors.lastname: Stone
authors.forename: Jenny E
authors.initials: JE
authors.lastname: Murase
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D001941:Breast Diseases / Q000175:diagnosis* / Q000473:pathology; D001942:Breast Feeding; D002177:Candidiasis / Q000175:diagnosis / Q000188:drug therapy; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008413:Mastitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D008875:Middle Aged; D009558:Nipples; D010146:Pain / Q000209:etiology*; D011928:Raynaud Disease / Q000175:diagnosis* / Q000473:pathology; D012189:Retrospective Studies; D017211:Treatment Failure
chemical_list: D000935:Antifungal Agents