What Causes Peau D’Orange?

Peau d’orange means "skin of an orange." In terms of your skin, it's not a disease, but a symptom of something else.

Swelling causes it; usually because of fluid buildup (your doctor may call it edema). The top layer of your skin (called the epidermis) expands to make room for the swelling. But evenly spaced pores on your skin hold spots down like buttons on a cushion, forming little holes, or “pits,” like the skin of an orange.

It may cause the breast -- a common spot for this -- to feel sore, swollen, and heavy. Your skin may feel leathery to the touch, too.

Lots of things can inflame, redden, or thicken breast tissue and make it sore. Pregnancy, breastfeeding, your monthly period, and skin problems can all do it. Peau d’orange adds the distinctive tiny indents, or “pits,” like the skin of an orange.

Inflammatory breast cancer (IBC) is the most serious cause of peau d’orange in the breast. A number of less serious conditions also might cause it.

Inflammatory Breast Cancer

IBC is rare. It makes up about 5% of all breast cancer cases. It tends to be very aggressive, so it requires treatment right away.

IBC cells block lymph vessels in the skin of your breast. That causes a buildup of lymphatic fluid from the small pockets of tissue (lymph nodes) under your arm or above your collarbone. That can cause peau d'orange.

Other symptoms of IBC, which often appear in one breast, can come about quickly. They may include:

  • Pain, tenderness, and itchiness
  • A larger or heavier breast
  • A warmer breast
  • Swelling
  • Redness on more than a third of the breast
  • A flat or pointed-inward nipple

Treatment for IBC could include:

Surgery usually requires removal of the entire breast. If the cancer has spread to lymph nodes or somewhere else in your body, your doctor may choose to skip the surgery and go right to other therapies like chemotherapy and radiation.

Edema

Fluid buildup is the main cause of peau d’orange. Lots of things can cause that buildup, not just cancer.

In lymphedema, for example, excess lymph fluid builds up. Normally, your lymphatic system helps filter and clear your body, including your breasts, of bacteria, other germs, and waste.

Lymphedema is more common after breast cancer treatment. It's usually found in the arm or hand. But it could happen in the breast, too.

Other causes of edema are:

Besides swelling, symptoms of edema include:

  • Tingling or numbness (lymphedema)
  • Tight or leathery skin
  • Skin that feels thicker or tougher
  • A heavy feeling

Your doctor will try to treat the cause of your edema first. After that, your doctor might suggest:

WebMD Medical Reference Reviewed by Jennifer Robinson, MD on May 25, 2020

Sources

SOURCES:

Mary Spraker, MD, dermatologist, The Emory Clinic.

American Cancer Society: “Treatment of Inflammatory Breast Cancer,” “Inflammatory Breast Cancer.”

Breastcancer.org: “Lymphedema.”

CDC: “Lymphedema.”

Cleveland Clinic: “Edema,” “Inflammatory Breast Cancer.”

European Society of Radiology: “Breast edema. A pictorial review with pathologic correlation.”

Mayo Clinic: “Inflammatory breast cancer,” “Mastitis,” “Edema.”

Mayo Clinic Proceedings: “Breast Peau d'Orange From Large Cell Lymphoma.”

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