Peau d'Orange: Causes and Treatment

Peau d'orange is a French term, meaning "orange peel" or "orange skin." It is used to describe a medical symptom whereby the skin becomes thick and pitted with a texture and appearance similar to that of orange peel.

It is sometimes accompanied by redness and tenderness of the skin, scaling, and a dark coloring. Peau d'orange can appear for a range of reasons, some more serious than others.

Causes and associated symptoms of peau d'orange

Peau d'orange can be caused by several different conditions. Each cause has its own associated symptoms.

Cellulite

                                         Cellulite is common and may appear more in women than men.

A common skin condition in which the skin becomes bumpy and dimpled, due to enlarged fat cells beneath the skin. Cellulite tends to appear on the buttocks, thighs, hips, and abdomen. It is more common in women than men and is usually not serious.

The following can help to reduce the appearance of cellulite:

§  Losing weight and healthy eating

§  Liposuction

§  Laser and radiofrequency systems

§  Retinol cream (0.3 percent)

Graves' dermopathy

Also known as pretibial myxedema, Graves' dermopathy is a skin condition usually affecting the tops of the feet and shins. It is caused by a buildup of certain types of carbohydrates in the skin.

The skin becomes swollen and red, with an orange peel-like texture. Graves' dermopathy has been defined as "an autoimmune manifestation of Graves' disease," which is an immune system disorder that causes the thyroid gland to produce too many thyroid hormones.

Less severe cases of Graves' dermopathy usually improve over time. They do not require treatment, other than that already aimed at managing an overactive thyroid in Graves' disease.

Infection

If a skin or soft tissue infection is causing peau d'orange, treating the underlying infection can treat it. Treatment will vary depending on the cause of the infection.

Lymphedema

             Bandaging the affected arm or leg may help to reduce swelling but should be supervised by a doctor.

The lymphatic system is in charge of flushing harmful substances such as viruses and bacteria out of the body. It does this through the lymph nodes and lymph vessels.

When these become damaged or blocked, they are unable to drain lymph fluid, and this is 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:

§  Gentle exercises to aid drainage of lymph liquid

§  Bandaging the affected arm or leg to encourage lymph fluid to shift back toward the trunk of the body

§  Manual lymph drainage massage to encourage drainage of lymph liquid out of the arm or leg

§  Applying compression to help lymph fluid to flow

§  Complete decongestive therapy (CDT) - not recommended in cases of heart failure, diabetes, high blood pressure, blood clots, or serious infections

All the above treatments should be supervised or carried out by a doctor. Massage should be avoided in cases involving skin infection, blood clots, or cancer.

Pseudoxanthoma elasticum

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 normal ability to expand and contract.

In the case of blood vessels, this can lead to high blood pressure or angina. It can also damage the eye retina and lead to a loss of vision. A symptom of pseudoxanthoma elasticum is peau d'orange, which can develop in the armpits, neck, stomach, and groin.

There is no actual cure for pseudoxanthoma, so the aim of treatment is 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 1 to 4 percent of diagnoses. In this type of cancer, the breast tissue becomes inflamed due to cancer cells blocking the small lymph ducts inside the breast.

Signs and symptoms include:

§  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 less commonly forms a lump than other types of breast cancer. It can appear quite suddenly and is sometimes confused with mastitis, an infection of the breast. Mastitis tends to occur in pregnant women or those breastfeeding. It is rare in women of menopausal age.

Diagnosis and treatment of breast cancer

                                        A mammogram may help to diagnose breast cancer.

A diagnosis is made through:

§  Physical examination.

§  Biopsy: Small tissue samples are taken from the breast and examined under a microscope. A biopsy may also be taken from the lymph nodes under the arm.

§  Mammogram: A low-dose X-ray of the breast tissue. The breast tissue is flattened to obtain the clearest picture. It is common for two mammograms to be taken of each breast from different angles.

§  Ultrasound or other imaging tests such as MRIs.

Inflammatory breast cancer tends to spread fairly quickly, so treatment is often started immediately after a diagnosis is confirmed.

Treatments are both:

§  Local, focusing on the area of the breast

§  Systemic, treating the body as a whole

These may include:

§  Chemotherapy - usually given before surgery as a way to shrink the cancer before to surgery

§  Surgery - usually in the form of a mastectomy

§  Radiotherapy - often used after chemotherapy and surgery to destroy any remaining cancer cells

§  Targeted therapy - medications such as trastuzumab and pertuzumab help block a protein that helps cancer cells to grow, causing them to die

§  Hormone therapy - in cases where the inflammatory breast cancer is sensitive to hormones

Prevention of breast cancer

Although it may not be possible to prevent cancer, the following may help reduce the chances of it developing or spreading:

§  Knowing what signs and symptoms to look out for

§  Having age-appropriate screenings

§  A healthy lifestyle: 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