Raynaud's Phenomenon, Candidiasis, and Nipple Pain Strategies for Differential Diagnosis and Care

Breastfeeding pain is the second most common reason women stop breastfeeding (Strong, 2011); therefore it should be recognized early and treated promptly. Often pain from primary Raynaud's Phenomenon of the Nipple (RP-n) imitates Candidiasis, misleading providers who prescribe antifungal medications. Unfortunately, the correct diagnosis comes after multiple doses of medication and no improvement in breastfeeding pain. Antifungals can further complicate diagnosis because they can cause nipple vasospasm as a side-effect of treatment (Bonyata, 2011). This article presents a case study of RP-n mistaken for Candidiasis. Evidenced-based treatment strategies, education, and close follow-up are minimum standards of care for women with breastfeeding pain. Fragmented healthcare systems can interfere with coordinated, evidence-based care. Raynaud's and Candidiasis can present in very similar manners resulting in a clinical dilemma for providers. However, excellent systematic clinical assessment focusing on the characteristics of the pain can help to differentiate between the two conditions. An algorithm to assist providers in differentiating between the two has been developed.