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Jan 27, 2022
5 min read

What is peau d’orange? Does it always mean breast cancer?

Peau d’orange (French for “orange peel”) is a condition that affects the skin on the breast. The skin may appear thick, pitted, firm, and bumpy—just like an orange peel. Peau d’orange may be associated with inflammatory breast cancer, but cancer isn’t the only reason you might get it.

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

Peau d’orange is a term used by medical professionals to describe the rough, bumpy, pitted skin that can sometimes appear on the breast. The word itself comes from the French word for orange peel, and the condition looks quite similar. 

Peau d’orange can sometimes be linked to inflammatory breast cancer, but that’s not the only reason it appears. Other things that can cause peau d’orange include infections, mastitis (breast tissue inflammation), and changes in the fat composition of the breast.

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What is peau d’orange? 

Thickened, firm, bumpy, and pitted skin can appear on the breast due to a variety of underlying conditions. It’s sometimes called pseudo-cellulitis because it can appear similar to cellulitis. When we say cellulitis, we’re not talking about the bumpy appearance of fat that can accumulate in the butt and thighs. That’s called cellulite. We’re talking about an infection in the skin that can appear red, bumpy, or uneven. 

In the case of peau d’orange, the affected breast might feel tender or develop sores or a scaly rash. Peau d’orange isn’t a disease by itself. That said, it may be a sign of an underlying medical condition and should prompt a visit with your healthcare provider. That’s because it can be caused by an infection or inflammation, which often requires further evaluation.              

Peau d’orange and breast cancer

Peau d’orange is sometimes a sign of inflammatory breast cancer (IBC). IBC only makes up about 2.5% of cases of breast cancer, making it rare, but it can be aggressive and spread quickly, so it’s a good idea to know the warning signs (Robertson, 2010). 

IBC can also be tricky to detect. That’s because this type of cancer starts inside small structures called lymphatic vessels, so you may not feel a lump right away. Signs that peau d’orange might be associated with IBC include:

  • Redness and swelling in your breast, especially if the redness appears in lines (lymphedema)
  • Swollen lymph nodes in your armpit that feel like raised spheres
  • Rapid growth of one breast compared to the other
  • Breast pain
  • If your nipple turns inward (inverted nipple)

Even if you don’t have any of these symptoms, it’s always a good idea to talk to a healthcare provider about what could be triggering peau d’orange.

Other causes of peau d’orange

If you’re experiencing peau d’orange, know that it isn’t always a sign of breast cancer. Here are some other scenarios and conditions that may cause pitting and dimpling of the breast.  

Bacterial infection

Bacterial infections in the skin, which are particularly common in people who are breastfeeding or pumping, can be very uncomfortable. Bacteria can get under your skin and cause an infection there (that’s the cellulitis we mentioned above). Sometimes, it can look a lot like peau d’orange. It can happen anywhere on the body, and treatment involves a course of antibiotics. 

Mastitis

When an infection in the breast is deeper than the skin and reaches the milk ducts and glands, it’s know as mastitis. Mastitis is seen commonly in people who are breastfeeding. 

A specific type of mastitis called idiopathic granulomatous mastitis causes swelling, pain, redness, and dimpling of the breast skin. Unlike traditional mastitis, which is associated with breastfeeding, the cause is typically unknown. Treatment is similar for both conditions and typically involves antibiotics. For the second type, steroids are often added (Wolfrum, 2018).

Lymphedema

Lymphedema, or redness or swelling from blocked lymph vessels, can cause peau d’orange in other conditions besides IBC. This includes pregnancy, heart failure, breast trauma, and radiation therapy (Verbelen, 2021). 

Fibrocystic breast disease

While the name sounds alarming, fibrocystic breast disease refers to benign changes in the breast. These changes may present as lumps, swelling, nipple discharge, and peau d’orange. It’s a very common condition seen in up to 60% of women (Malherbe, 2021). 

Cellulite

Cellulite is a common skin finding seen in 80–90% of women following puberty. Sometimes called “chicken skin,” cellulite may look tough and dimpled like peau d’orange, but isn’t harmful (Luebberding, 2015). 

Less common conditions can also cause peau d’orange. There are cases of people who develop breast swelling, dimpling, and redness from conditions like thyroid disease and lymphoma (Du, 2021; Tefferi, 2004). 

What to do if you have peau d’orange

If you have peau d’orange, the first thing to do is visit a healthcare professional. They can help you figure out what is causing your breast dimpling and how to treat it. Your provider will likely perform a thorough breast examination and decide whether you need further tests like a mammogram or biopsy. 

While the appearance of peau d’orange can be alarming, it’s a good idea to visit your healthcare provider to get a full assessment and take care of your health.

References

  1. Baslaim, M. M., Khayat, H. A., & Al-Amoudi, S. A. (2007). Idiopathic granulomatous mastitis: a heterogeneous disease with variable clinical presentation. World Journal of Surgery, 31(8), 1677–1681. doi:10.1007/s00268-007-9116-1. Retrieved from https://pubmed.ncbi.nlm.nih.gov/17541683/
  2. Benavente Villegas, F. C., Alfageme Roldán, F., & Suárez Massa, D. (2020). Peau d’Orange Appearance (Pseudocellulitis) and Elastography. Signo de piel de naranja (seudocelulitis) y elastografía. Actas Dermo-Sifiliograficas, 111(7), 612. doi:10.1016/j.ad.2018.09.028. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32531239/
  3. Du, T., Jiang, W., Luo, H., Chen, F., Yuan, G., Zhang, M., et al. (2021). Bilateral breast myxedema caused by Graves’ disease and responsive to multipoint subcutaneous injection of long-acting glucocorticoid: Case report. Medicine, 100(25), e26469. doi:10.1097/MD.0000000000026469. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8238392/
  4. Fatourechi, V. (2005). Pretibial myxedema: pathophysiology and treatment options. American Journal of Clinical Dermatology, 6(5), 295–309. doi:10.2165/00128071-200506050-00003. Retrieved from  https://pubmed.ncbi.nlm.nih.gov/16252929/
  5. Luebberding, S., Krueger, N., & Sadick, N. S. (2015). Cellulite: an evidence-based review. American Journal of Clinical Dermatology, 16(4), 243–256. doi:10.1007/s40257-015-0129-5. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25940753/
  6. Malherbe, K., Khan, M., & Fatima, S. (2021). Fibrocystic Breast Disease. [Updated Oct 24, 2021]. In StatPearls. StatPearls Publishing. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31869073/ 
  7. Pervane Vural, S., Ayhan, F. F., & Soran, A. (2020). The Role of Patient Awareness and Knowledge in Developing Secondary Lymphedema after Breast and Gynecologic Cancer Surgery. Lymphatic Research and Biology, 18(6), 526–533. doi:10.1089/lrb.2020.0059. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33026963/
  8. Robertson, F. M., Bondy, M., Yang, W., Yamauchi, H., Wiggins, S., Kamrudin, S., et al. (2010). Inflammatory breast cancer: the disease, the biology, the treatment. CA: A Cancer Journal for Clinicians, 60(6), 351–375. doi:10.3322/caac.20082. Retrieved from https://pubmed.ncbi.nlm.nih.gov/20959401/
  9. Tefferi, A. & Colgan, J. P. (2004). Breast peau d’orange from large cell lymphoma. Mayo Clinic Proceedings, 79(2), 187. doi:10.4065/79.2.187. Retrieved from https://pubmed.ncbi.nlm.nih.gov/14959913/
  10. Verbelen, H., Tjalma, W., Dombrecht, D., & Gebruers, N. (2021). Breast edema, from diagnosis to treatment: state of the art. Archives of Physiotherapy, 11(1), 8. doi:10.1186/s40945-021-00103-4. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33775252/
  11. Wiggett, W. S., Louw, M., & Karusseit, V. O. (2012). The histology of peau d’orange in breast cancer – what are the implications for surgery? South African Journal of Surgery, 50(3): 75–78. doi:10.7196/sajs.1103. Retrieved from https://pubmed.ncbi.nlm.nih.gov/22856439/
  12. Wolfrum, A., Kümmel, S., Theuerkauf, I., Pelz, E., & Reinisch, M. (2018). Granulomatous Mastitis: A Therapeutic and Diagnostic Challenge. Breast Care (Basel, Switzerland), 13(6), 413–418. doi:10.1159/000495146. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6381909/