What Causes Peau D’Orange?

If you’ve observed small dimples in your skin that resemble the texture of an orange peel, you might be curious about what’s causing them.

This sign is called peau d’orange, a French phrase meaning “orange skin.” It can appear on many parts of the body and may affect the breasts in both sexes.

Along with peau d’orange, you might notice other signs such as:

• swelling
• redness
• tenderness
• wounds with dark scabs
• scales or dry, flaky patches

The presence of additional signs and the specific location of the peau d’orange can help point toward its underlying cause.

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Causes

Numerous conditions can produce peau d’orange.

Breast cancer

When peau d’orange appears on the breast, it can be a manifestation of inflammatory breast cancer. In this form of cancer, rather than forming a discrete lump, cancer cells obstruct the lymphatic channels.

Such blockage leads to fluid buildup in the breast. This accumulation, called edema, can make the breast look swollen and inflamed.

Besides peau d’orange, inflammatory breast cancer may cause:

• swelling and redness that may cover a third or more of the breast
• a pink, red, purple, or bruised-looking skin tone
• a rapid enlargement of the breast
• feelings of heaviness, burning, aching, or soreness in the breast
• a nipple that turns inward
• enlarged lymph nodes under the arm, near the collarbone, or both

Peau d’orange on the breast does not automatically mean you have breast cancer, but it can be a warning sign. It’s important to consult your healthcare provider if you notice it on your breast.

Lymphedema

Lymphedema is swelling that results from a blockage in lymphatic vessels. Primary lymphedema arises spontaneously, while secondary lymphedema can be caused by various factors such as:

• cancer
• treatment or surgery for malignant conditions
• infections
• chronic venous insufficiency
• congenital abnormalities
• obesity

Whatever the origin, the accumulated lymphatic fluid can increase the risk of infection.

If you suspect lymphedema, see your doctor so they can identify the root cause and begin appropriate therapy. Treatment can reduce infection risk and other complications.

Infection

Skin and soft tissue infections may produce peau d’orange. For example, Acinetobacter baumannii can cause cellulitis, an infection of the skin and underlying tissues, which may result in peau d’orange.

A. baumannii can also cause bloodstream and urinary tract infections and may lead to ventilator-associated pneumonia in hospitalized patients on mechanical ventilation.

Cellulite

Cellulite is uneven fat deposits just beneath the skin that create a dimpled, bumpy appearance. It’s estimated to affect 80 to 90 percent of women.

Although cellulite can look like an orange peel, it’s not commonly labeled as peau d’orange.

Cellulite is more prevalent in women than men and is more likely in people who are overweight or who have a family history of it.

Breast swelling

If your breasts become enlarged or swollen, such as during pregnancy, you may notice peau d’orange on them. This can be benign and related to the normal changes of pregnancy.

However, pregnant women can still develop inflammatory breast cancer, so report any peau d’orange to your healthcare provider promptly. If the appearance is benign during pregnancy, it typically resolves once the swelling decreases.

Diagnosis

When you see your doctor about peau d’orange, they will conduct a physical exam and may perform a biopsy of the affected area if inflammatory breast cancer is suspected.

A tissue biopsy is a brief procedure, usually performed with local anesthesia in an office setting. The sample is then sent to a pathology laboratory for examination.

Your physician may also order a mammogram or breast MRI. An MRI is sometimes preferred because mammograms can miss cases of inflammatory breast cancer.

Treatment

Treatment generally targets the underlying cause of peau d’orange rather than the skin change itself. Management varies based on the diagnosis.

Breast cancer

Treatment for inflammatory breast cancer typically includes:

• chemotherapy
• surgery
• radiation therapy
• hormonal therapy
• targeted treatments

Specific therapies depend on the cancer’s stage and subtype. Because inflammatory breast cancer is aggressive, surgery often involves a modified radical mastectomy with lymph node removal.

Since peau d’orange in breast cancer reflects the disease itself, it usually improves if the cancer responds to therapy.

Lymphedema

Treatment for lymphedema varies by location and severity. Common approaches include:

• compression garments
• therapeutic exercise
• manual lymphatic drainage (massage)
• elevation of the affected limb

Infections that occur with lymphedema are treated with antibiotics and may sometimes require drainage or surgical intervention.

Infection

If a skin or soft tissue infection is responsible, addressing the infection typically resolves the peau d’orange. Specific treatment depends on the infectious agent.

Cellulite

You might lessen the visibility of cellulite by:

• losing excess weight
• regular exercise
• using topical creams or oils
• massaging the area
• applying local heat

Outlook

Peau d’orange can arise from a range of causes. When it appears on the breast, particularly if it develops quickly, it could indicate inflammatory breast cancer.

If you notice peau d’orange, and especially if it involves the breast, seek medical attention right away. Early, accurate diagnosis is crucial for effective treatment.