Unilateral, Episodic, Transient Blanching of Nipple With Pain in a Male: A Case Report

Causes of nipple pain include trauma, vasospasm, malignancy, Paget's disease, inflammation secondary to blockage of the ducts, infection, and medications. Raynaud's phenomenon (RP) of the nipple is reported more often in women and typically presents bilaterally.

A 63-year-old man presented with episodic, stabbing pain and blanching of the left nipple, worsening over 3 years. Symptoms began insidiously during military service. Examination revealed no abnormalities, but blanching was observed during a painful episode. Laboratory and imaging studies were unremarkable. Conservative measures and pharmacologic agents, including nitroglycerin ointment and amlodipine, provided minimal relief. Intercostal nerve blocks and cervical sympathetic blocks did not provide lasting relief. Ultrasound-guided paravertebral sympathetic block with local anesthetic provided temporary relief lasting week. Botulinum toxin injection around the areola resulted in sustained pain relief lasting more than month.

The patient's presentation is consistent with primary RP of the nipple, a rare and underrecognized condition. While it typically affects distal extremities, it can involve other areas, including the nipple. Diagnosis is clinical, often requiring documentation during episodes. Management is challenging and largely anecdotal. Botulinum toxin has shown promise in RP, though evidence remains mixed.

This case highlights a rare presentation of unilateral, vasospastic nipple pain resembling primary RP, with partial response to botulinum toxin injection.