Differential Diagnosis for Nipple Blister and Pain while Breastfeeding

• Single most likely diagnosis:
  • Nipple thrush: This is a common condition in breastfeeding mothers, caused by a yeast infection (Candida). It leads to nipple pain, blisters, and sometimes breast pain. The pain is often described as sharp or burning and can be severe enough to cause mothers to dread feeding sessions.
• Other Likely diagnoses:
  • Nipple trauma or abrasion: Incorrect latching or positioning during breastfeeding can cause friction and lead to nipple blisters and pain.
  • Ductal ectasia: A condition where the milk ducts beneath the nipple become widened, leading to inflammation, nipple retraction, and sometimes blistering.
  • Raynaud’s phenomenon of the nipple: A condition causing blood vessels in the nipple to spasm, leading to pain and sometimes blisters during breastfeeding.
• Do Not Miss diagnoses:
  • Breast cancer: Although rare, any new nipple blister or persistent pain should prompt an evaluation to rule out underlying breast cancer, especially if accompanied by other symptoms like a lump, nipple discharge, or skin changes.
  • Inflammatory breast cancer: A rare but aggressive form of breast cancer that can cause skin changes, including blisters, and is often mistaken for infection.
  • Paget's disease of the breast: A rare form of breast cancer that affects the skin of the nipple and, sometimes, the areola, causing eczema-like changes, blisters, and pain.
• Rare diagnoses:
  • Eczema (atopic dermatitis) of the nipple: Can cause blistering, itching, and pain, but is less common in the context of breastfeeding.
  • Psoriasis of the nipple: Although psoriasis can occur anywhere on the body, it's rare on the nipple and can cause blistering and pain.
  • Contact dermatitis: An allergic reaction or irritation from soaps, creams, or other products used on the nipple, leading to blisters and pain.