What to know about peau d'orange
Redness and tenderness of the skin, scaling, and a dark coloring sometimes accompany. Peau d'orange can appear for a range of reasons, some more serious than others.
In this article, we address the different causes and related treatments for peau d'orange, as well as casting a closer eye on breast cancer, one of the more dangerous underlying reasons for orange-peel skin.
Causes and treatment
Peau d'orange can be the result of several different medical conditions. Each cause has its own symptoms and treatment methods, and treating the underlying condition often resolves the orange-peel appearance of the skin.
This section looks at the different reasons for peau d'orange and their possible treatments.
Many people have cellulite, also known as peau d'orange.
Cellulite is also known as peau d'orange due to its texture.
This is a common skin condition in which the skin becomes bumpy and dimpled. Enlarged fat cells beneath the skin cause cellulite. It tends to appear on the buttocks, thighs, hips, and abdomen and occurs in 80–90 percent of women after puberty.
The following can help to reduce the appearance of cellulite:
- weight management
- a nutritious, balanced diet
- laser and radiofrequency systems
- retinol cream with a 0.3 percent concentration
Also known as pretibial myxedema, Graves' dermopathy is a skin condition that usually occurs on the tops of the feet and shins. A build-up of certain types of carbohydrates in the skin leads to this condition.
The skin becomes swollen and red alongside its peau d'orange appearance.
Healthcare professionals define Graves' dermopathy as "an autoimmune manifestation of Graves' disease." Graves' disease is an immune system disorder that causes the thyroid gland to produce too many thyroid hormones.
Less severe presentations of Graves' dermopathy usually improve over time. They do not require treatment, other than any already existing management of the excess thyroid activity in Graves' disease.
If a skin or soft tissue infection is causing peau d'orange, treating the underlying infection can help manage the effects.
Treatment will vary depending on the cause of the infection. Antibiotic creams and ointments may help.
The lymphatic system removes harmful substances and organisms, such as viruses and bacteria, from the body through the lymph nodes and lymph vessels.
When these become damaged or blocked, they are unable to drain lymph fluid, and this develops into a condition known as lymphedema.
Lymphedema causes the skin to swell and usually occurs in the arms or legs. The skin can take on the appearance of peau d'orange.
Possible causes of lymphedema are infection of the lymph nodes, cancer and cancer treatment, and surgical removal of the lymph nodes.
Although there is no cure for lymphedema, there are treatments that can help reduce the swelling and pain. These include:
- bandaging the affected arm or leg to encourage the shifting of lymph fluid back toward the trunk of the body
- gentle exercises to aid drainage of lymph liquid
- manual lymph drainage massage to encourage drainage of lymph liquid out of the arm or leg
- applying compression to help the flow of lymph fluid
- complete decongestive therapy (CDT), which is not recommended in cases of heart failure, diabetes, high blood pressure, blood clots, or serious infections
A doctor should carry out or supervise all the above treatments. Massage is not safe or effective in lymphedema that occurs due to skin infection, blood clots, or cancer.
Elastic fibers are present in the skin and connective tissues in the body, giving them flexibility and strength. Pseudoxanthoma elasticum causes these fibers to harden and lose their ability to expand and contract.
This can lead to high blood pressure or angina if it occurs in the blood vessels. It can also damage the retina at the back of the eye and cause vision loss. A symptom of pseudoxanthoma elasticum is peau d'orange, which can develop in the armpits, neck, stomach, and groin.
There is no full cure for pseudoxanthoma, so treatment aims to prevent complications.
Inflammatory breast cancer
One of the most serious causes of peau d'orange is inflammatory breast cancer, a rare type of cancer that makes up only between one and five out of 100 breast cancers, or 1–5 percent of diagnoses.
In this type of cancer, the breast tissue becomes inflamed due to the blockage of the small lymph ducts inside the breast by cancer cells.
- peau d'orange
- noticeable enlargement of one breast
- redness or a bruised appearance
- hot feeling
- soreness or pain
- swollen lymph nodes under the arm, or in the collarbone surrounding area
- an inverted nipple
Inflammatory breast cancer is less likely to form a lump than other types of breast cancer. It can appear quite suddenly and sometimes appears to be mastitis, an infection of the breast.
Mastitis tends to occur in women during pregnancy and breastfeeding, and it is rare in women of menopausal age.
Managing breast cancer
Many avenues of treatment are available for breast cancer.
The link between peau d'orange and inflammatory breast cancer means that recognizing and treating the condition before it progresses is vital.
A doctor makes a diagnosis using the following methods:
- Physical examination: A doctor checks for signs of inflammatory breast cancer, including peau d'orange.
- Biopsy: The doctor extracts small tissue samples from the breast and sends them to a laboratory for examination under a microscope. A biopsy may also come from the lymph nodes under the arm.
- Mammogram: This is a low-dose X-ray of the breast tissue. The healthcare professional flattens the breast tissue to obtain the clearest picture. It is common for a technician to take two mammograms of each breast from different angles.
- Ultrasound or other imaging tests, such as MRIs: These can help produce a clearer picture of the breast, including the extent and spread of the cancer cells.
Inflammatory breast cancer tends to spread fairly quickly, so treatment often commences immediately after diagnosis.
Treatments involve two approaches, including:
- Local: These focus specifically on the area of the breast.
- Systemic: These treat the body as a whole to reduce or manage the spread of cancer.
Measures might include the following:
- Chemotherapy: The medical team flush the body with chemicals that are toxic to cancer cells, often before surgery as a way to shrink a tumor or reduce the extent of cancer before removing it.
- Surgery: With inflammatory breast cancer, this often takes the form of a mastectomy, or removal of one or both breasts.
- Radiation therapy: The medical team targets a specific area with intense radiation that damages cancer cells and shrinks tumors. Radiation therapy often comes into play following chemotherapy and surgery to destroy any remaining cancer cells
- Targeted therapy: Medications such as trastuzumab and pertuzumab help block a protein involved in the growth of cancer cells, causing them to die.
- Hormone therapy: In cases where the inflammatory breast cancer is sensitive to hormones, supplementation of these hormones can help reduce the cancer
Preventing breast cancer
Although preventing inflammatory breast cancer may not be possible, the following steps may help reduce its chances of developing or spreading:
- being able to identify the symptoms, such as peau d'orange
- receiving regular, age-appropriate screenings
- regular exercise, a balanced diet, reducing alcohol intake
- knowing about any cancer-related family history
- breastfeeding may help reduce the risk of developing breast cancer
While orange-peel skin is not always a sign of breast cancer, knowing about it and spotting it can be important for preventing a range of potentially harmful conditions and diseases.
Seek medical attention if peau d'orange appears on the breast.
Peau d'orange means "orange peel" in French, and refers to the appearance of the skin as bumpy. Other symptoms, such as redness and soreness, might accompany orange peel skin.
It can point to a range of conditions, such as cellulite, which is very common in women, several types of infections, and lymph disorders, such as Graves' dermopathy and lymphodema.
Each cause requires a different treatment depending on the underlying condition.
The skin condition might also be a result of an aggressive form of breast cancer and might accompany the enlargement of one breast, a "hot" feeling around the affected area, soreness, and redness.
Seek treatment immediately if peau d'orange accompanies any of these symptoms in the breast area.
Is peau d’orange harmful in of itself?
Peau d’orange in and of itself is not harmful, the term simply describes a thickening and pitting of skin.
However, the appearance of peau d’orange skin can be a symptom of an underlying condition. The underlying condition can be serious, and you should see a doctor for an assessment to determine what is causing the peau d’orange skin.
If you have peau d’orange in the breast area it is important to seek attention immediately.Debra Sullivan, PhD, MSN, RN, CNE, COI Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.