What is Peau D’Orange?
Peau D’Orange is a symptom where the skin takes on the appearance of an orange peel, .i.e. it becomes thick and pitted like an orange. Peau D’Orange is a French term, which means “skin of an orange.” Peau D’Orange can be a symptom of serious condition; however, Peau D’Orange itself is not life-threatening on its own that is. It can cause embarrassment or discomfort to the patient, but is not a serious condition.
Peau D’Orange can develop anywhere on the skin and can be found on the breasts of both women and men, which can be a sign of breast cancer. Various causes lead to development of Peau D’Orange. Some of the common causes of Peau D’Orange include inflammatory breast cancer, Grönblad–Strandberg syndrome (pseudoxanthoma elasticum or PXE) and Grave's disease. Peau D’Orange in a patient with breast cancer is a late indication of the disease. There is thickening and pitting of the skin on the breast with pain and noticeable lumps. This is because in breast cancer, the swelling in the breast becomes so extreme that the hair follicles appear as pits or dimples. The cause of this acute breast swelling is lymphatic edema, where there is accumulation of water in the lymphoid tissue present in the breast. The point to remember here is, Peau D’Orange need not necessarily indicate breast cancer when it develops on the breast and can be from a harmless cause also. Treatment of Peau D’Orange comprises of treating the underlying cause of Peau D’Orange.
Symptoms of Peau D’Orange
Peau D’Orange itself is a symptom of some underlying condition where the patient’s skin appears dimpled and pitted like the orange rind. Other symptoms, which the patient experiences along with Peau D’Orange includes: Redness, swelling, tenderness, dry flaky skin or scales and wounds with black scabs. Other symptoms along with the location/site of the Peau D’Orange help in finding the cause of this symptom.
Causes of Peau D’Orange
There are various causes or medical conditions, which lead to Peau D’Orange in a patient and some of them, are described below:
Breast Cancer: If the patient is having Peau D’Orange in the breast, then it can be a sign of inflammatory breast cancer where the cancer cells, instead of forming a tumor, block the lymphatic vessels resulting in buildup of fluid in the breast (edema) and inflammation. Other than Peau D’Orange, other symptoms of inflammatory breast cancer are:
- Redness and swelling on the breast.
- The skin on the breast appears bruised or a pink, purple, reddish color.
- Patient experiences heaviness, pain, tenderness or burning in the breast.
- The size of the breast increases rapidly.
- There is an inward-facing nipple.
- Patient has swollen lymph nodes in the armpits and near the collarbone.
If the patient has Peau D’Orange on the breast, it does not always mean that the patient has breast cancer; however, it is an important sign and should never be ignored.
Pseudoxanthoma Elasticum: Peau D’Orange can also occur as a symptom of Pseudoxanthoma Elasticum, which is a rare genetic disease where there is fragmentation and calcification of the elastic fibers of the skin, retina and the cardiovascular system. Patients suffering from Pseudoxanthoma Elasticum experience sagging of their skin with pitting and rough appearance to the skin. Pseudoxanthoma Elasticum initially appears on the neck and spreads to other areas of the face. As Pseudoxanthoma Elasticum worsens, the skin of the neck and groin becomes wrinkled and soft, along with having the pitted appearance of an orange rind.
Infection: Infection of the skin and soft tissue can also result in Peau D’Orange. Cellulitis, which is an infection of the skin and the tissues under the skin, can also lead to Peau D’Orange.
Lymphedema: In this condition, there is blockage of the lymph vessels which produce swelling and Peau D’Orange. Spontaneous blockage occurs in primary lymphedema. There are different causes for secondary lymphedema, which include: cancer and its treatment, infections, chronic venous insufficiency, obesity and birth defects. The blockage and accumulation of fluid in the lymph vessel can lead to infection. So, it is important to seek medical attention, as soon as you experience this, as early diagnosis and treatment helps in reducing the risk of infection and its complications.
Cellulite: Cellulite is the presence of stubborn, uneven, subcutaneous deposits of fat, which gives the skin a bumpy and dimpled appearance. It is more commonly seen in women, particularly on hips and thighs. Even though cellulite gives the skin an appearance of an orange rind, it is not commonly referred to as Peau D’Orange.
Breast Swelling: Some conditions, such as pregnancy, cause the breasts to become enlarged or swollen, which can also lead to appearance of Peau D’Orange on the breasts. This is often benign. However, inflammatory breast cancer can occur in pregnant women also, so if there is a Peau D’Orange appearance on the breasts during pregnancy, then it is important to bring this to the attention of a doctor. If the Peau D’Orange is benign, then it resolves after the pregnancy.
Diagnosis of Peau D’Orange
To diagnose the cause of Peau D’Orange, the doctor will perform a physical exam. A biopsy is done if the doctor suspects that inflammatory breast cancer is the cause of Peau D’Orange. Biopsy is a procedure where a small sample of tissue is taken from the affected region and sent to lab for analysis. Mammogram or MRI of the breasts can also be done.
Treatment of Peau D’Orange
As Peau D’Orange is a symptom of some underlying condition, treating the cause of Peau D’Orange resolves it. Treatment depends on the underlying cause and comprises of:
Treatment of Peau D’Orange Caused Due to Breast Cancer comprises of surgery, chemotherapy, radiation therapy, hormonal therapy and targeted therapies. Treatment also depends on the type and stage of cancer. Surgery comprising of mastectomy and lymph node dissection is commonly done for inflammatory breast cancer. If the cancer responds to treatment, then the Peau D’Orange also resolves.
Treatment of Peau D’Orange Caused Due to Pseudoxanthoma Elasticum can be done through plastic surgery to remove the bumps and sagging skin associated with this condition.
Treatment of Peau D’Orange Caused Due to Lymphedema depends on the severity and the location of the swelling and commonly includes exercises, compression garments, massage and elevation of the affected region. Antibiotics are prescribed for infections and some patients may also require incision and drainage or surgery.
Treatment of Peau D’Orange Caused Due to Infection consists of treating the underlying infection, which is causing the Peau D’Orange and treatment also depends on the cause of infection.
Treatment of Peau D’Orange Caused Due to Cellulite consists of losing the excess weight, exercising, massaging, topical creams and localized heat application.