Raynaud's phenomenon of the nipple as a side-effect of labetalol: Case report and literature review

Avila-Vega, Jesus; Urrea-Mendoza, Enrique; Lee, Christy

doi:10.1016/j.crwh.2019.e00135

Cited by 8 publications

(7 citation statements)

References 17 publications

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“…Raynaud phenomenon (RP) is characterized by vasospasm of arterioles causing intermittent ischemia and reflex vasodilatation. Vasospasm is a physiological response to cold temperatures but can also be secondary to stress, caffeine consumption, and smoking 3 . RP most commonly affects the hands and feet but other reported areas include coronary, gastrointestinal, placental, penile, and tongue 1,4,5 …”

Section: Discussionmentioning

confidence: 99%

“…RPN particularly affects pregnant and lactating patients, with risk of breastfeeding cessation due to pain 8 . Though primarily idiopathic, drug‐associated RPN with labetalol has been reported 3,8 . Also, literature has linked breast implants and autoimmune disorders including Raynaud's, and a case series of 12 lactating mothers suggested an association between history of breast surgery and RPN.…”

Section: Discussionmentioning

confidence: 99%

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Nipple pain: Raynaud's beyond fingers and toes

et al. 2020

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Raynaud's phenomenon of the nipple (RPN) is a cause of nipple pain scarcely reported in the literature and frequently missed by physicians. We present a case of RPN in a pregnant mother who sought breast surgical consultation for episodic nipple pain. Review of the literature reveals RPN is predominant in lactating and pregnant patients and missed diagnosis can cause cessation of breastfeeding or mistreatment with antifungals. Clinical suspicion should be raised if symptoms are precipitated by cold, associated with color change, occur during pregnancy or breastfeeding, or with a history of Raynaud's. Treatment is generally supportive, with nifedipine used for severe cases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Nipple pain: Raynaud's beyond fingers and toes

et al. 2020

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“…Certain medications, including drugs for migraine, cyclosporine, and nonselective beta-blockers, can also lead to secondary RP [ 31 ]. RP of the nipple has also been reported to occur following the administration of labetalol, a first-line drug employed for gestational hypertension [ 105 ], with the symptoms resolving on discontinuation of this drug.…”

Section: Reviewmentioning

confidence: 99%

Raynaud’s Phenomenon: Reviewing the Pathophysiology and Management Strategies

Nawaz¹,

Nawaz²,

Nawaz³

et al. 2022

Cureus

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Raynaud's phenomenon (RP) is a multifactorial vasospastic disorder characterized by a transient, recurrent, and reversible constriction of peripheral blood vessels. RP is documented to affect up to 5% of the general population, but variation in its prevalence is commonly recognized owing to many factors, including varied definitions, gender, genetics, hormones, and region. Furthermore, RP may be idiopathic or be a clinical manifestation of an underlying illness. Patients with RP classically describe a triphasic discoloration of the affected area, beginning with pallor, followed by cyanosis, and finally ending with erythema. This change in color spares the thumb and is often associated with pain. Each attack may persist from several minutes to hours.Moreover, the transient cessation of blood flow in RP is postulated to be mediated by neural and vascular mechanisms. Both structural and functional alterations observed in the blood vessels contribute to the vascular abnormalities documented in RP. However, functional impairment serves as a primary contributor to the pathophysiology of primary Raynaud's. Substances like endothelin-1, angiotensin, and angiopoietin-2 play a significant role in the vessel-mediated pathophysiology of RP. The role of nitric oxide in the development of this phenomenon is still complex. Neural abnormalities resulting in RP are recognized as either being concerned with central mechanisms or peripheral mechanisms. CNS involvement in RP may be suggested by the fact that emotional distress and low temperature serve as major triggers for an attack, but recent observations have highlighted the importance of locally produced factors in this regard as well. Impaired vasodilation, increased vasoconstriction, and several intravascular abnormalities have been documented as potential contributors to the development of this disorder. RP has also been observed to occur as a side effect of various drugs.Recent advances in understanding the mechanism of RP have yielded better pharmacological therapies. However, general lifestyle modifications along with other nonpharmacological interventions remain first-line in the management of these patients. Calcium channel blockers, alpha-1 adrenoreceptor antagonists, angiotensin-converting enzyme inhibitors, nitric oxide, prostaglandin analogs, and phosphodiesterase inhibitors are some of the common classes of drugs that have been found to be therapeutically significant in the management of RP. Additionally, anxiety management, measures to avoid colder temperatures, and smoking cessation, along with other simple modifications, have proven to be effective non-drug strategies in patients experiencing milder symptoms.

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“…Важно отметить, что во всех представленных случаях возникновение похолодания сосков совпало по времени с максимальной концентрацией лабеталола в плазме крови беременных женщин [35]. Единичные случаи развития синдрома Рейно сосков при применении лабеталола были официально зарегистрированы в Соединенном Королевстве и США [36,37].…”

Section: синдром рейноunclassified

Peculiarities of Adverse Events Manifested by Injury of Skin and Skin Derivatives and Associated with Beta-blockers Use

Matveev

Egorova

Konyaeva

et al. 2021

Racionalʹnaâ farmakoterapiâ v kardiologii

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More than 50 years after Propranolol was introduced to the pharmaceutical market as a drug that can lower the heart rate, beta-blockers (BAB) are still widely used in the pharmacotherapy of cardiovascular diseases. However, the use of BAB has a number of limitations, first of all, due to adverse drug events (AE) that develop during their use. The purpose of our review was to study the features of the BAB AE manifested by injuries of the skin and its appendages. The clinical manifestations of them are the development or exacerbation of psoriasis, lichen planus, contact dermatitis, acrocyanosis, Raynaud's disease, alopecia, hyperhidrosis, vitiligo, anaphylaxis, and allergic skin reactions. True medicinal psoriasis occurs in patients taking BAB with no family or previous history and most often mimics erythrodermic psoriasis and palmar-plantar pustular psoriasis. Systemic use of BAB can also be accompanied by exacerbation of vitiligo. In patients with segmental vitiligo, the results of Doppler flowmetry and iontophoresis showed increased blood flow in vitiligo foci compared with normal skin. The development of anaphylactic reactions against the background of BAB therapy may be due to the modulation of adenylate cyclase, which can affect the release of anaphylactogenic mediators, as well as a decrease in the severity of cardiovascular compensatory changes. The peculiarities of the development of such reactions may be the resistance of patients to traditional treatment, which is due to the development of paradoxical reflex vagotonic effects when using adrenaline. Some of the mentioned AE may pose a potential threat to the life and health of the patient and therefore require additional discussion.

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Raynaud's phenomenon of the nipple as a side-effect of labetalol: Case report and literature review

Cited by 8 publications

References 17 publications

Nipple pain: Raynaud's beyond fingers and toes

Nipple pain: Raynaud's beyond fingers and toes

Raynaud’s Phenomenon: Reviewing the Pathophysiology and Management Strategies

Peculiarities of Adverse Events Manifested by Injury of Skin and Skin Derivatives and Associated with Beta-blockers Use

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