23rd Annual Pain Medicine Meeting 2024

Raynaud’s Phenomenon of the Nipple in a Male

Introduction

•An unidentifiable primary cause of nipple pain, with associated color changes especially blanching, is called Raynaud’s phenomenon of the nipple

• Nipple pain with color changes can be an early presenting symptom of connective tissue disorders

Case Presentation

•63-year-old man presented with left nipple pain worsened over the last 3 years.

•He described it as starting as an ache lateral to the nipple-areolar complex with the nipple gradually turning white and erect

•Lasted 15-60 minutes and occurred 1-6 times daily

•PMHx included DM type 2 , hypertension and exposure to CARC paint and burn pits in the Gulf war

•Niitroglycerin paste, increase in amlodipine, stellate ganglion blocks, provided minimal relief.

•Paravertebral blocks with LA provided a week of relief

•Boutilinum toxin injection (80 units) around the areola provided more than a month of complete relief

Discussion

•RP is mostly a clinical diagnosis and is classically described as having a triphasic color change

•RP of the nipple has never been reported in men

•Management of Raynaud’s Phenomenon include lifestyle modifications like smoking cessation, and avoiding cold.

•Calcium channel blockers, ACE inhibitors, angiotensin receptor blockers, nitroglycerin paste and SSRIs, phosphodiesterase type-5 inhibitors

•.Cervical sympathetic blocks have had limited success

• Botulinum toxin injection has ben shown to beneficial in some

RAYNAUD'S PHENOMENON OF THE NIPPLE IN A MALE