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ULY CLINIC

15 Septemba 2025, 12:49:49

Peau d’orange

Peau d’orange refers to edematous thickening and pitting of the breast skin, resembling the surface of an orange. It is usually a late sign of breast cancer but may also occur with breast or axillary lymph node infection, erysipelas, or Graves’ disease. The characteristic appearance arises from lymphatic edema surrounding hair follicles.

History and Physical Examination

History

Ask when the patient first noticed the peau d’orange.
Inquire about associated breast changes: lumps, pain, nipple discharge, dimpling, retraction, or deviation.
Assess for systemic symptoms: malaise, fatigue, weight loss, fever.
Determine lactation status or recent weaning.
Ask about prior axillary or breast surgery that could impair lymphatic drainage.

Physical Examination

Observe breasts in a well-lit room, noting extent of peau d’orange and any erythema.
Assess nipples for discharge, cracking, retraction, deviation, or dimpling.
Gently palpate peau d’orange areas for warmth, induration, or tenderness.
Palpate the entire breast for fixed or mobile masses.
Examine axillary lymph nodes for enlargement or tenderness.
Record vital signs, including temperature, to assess for infection.

Medical causes of Peau d’Orange

Condition	Clinical Features	Other Important Information
Breast abscess	Usually lactating women; breast tenderness, erythema, indurated or soft mass, fever, shaking chills, possible purulent nipple discharge	Often related to milk stasis; cracked nipple may be present
Breast cancer (advanced)	Firm, immobile mass adherent to overlying skin; peau d’orange in dependent breast or areola; nipple deviation, erosion, retraction; watery, bloody, or purulent discharge; burning, itching, or warmth sensation	Changes in breast contour, size, symmetry; pain may be absent or unreliable indicator

Special considerations

Peau d’orange often indicates advanced breast cancer; provide emotional support.
Encourage the patient to express fears and concerns.
Explain expected diagnostic procedures: mammography, breast ultrasound, and biopsy.

Patient counseling

Teach monthly breast self-examinations.
Explain the purpose and procedure of diagnostic tests.
Advise prompt reporting of new lumps, skin changes, or nipple discharge.
Discuss emotional support resources and follow-up care.

Pediatric pointers

Rare in children; usually related to infection or inflammatory conditions rather than cancer.
Evaluate for systemic signs such as fever and erythema.

References

Sommers, M. S., & Brunner, L. S. (2012). Pocket Diseases. Philadelphia, PA: F.A. Davis.
Schuiling, K. D. (2013). Women’s Gynecologic Health. Burlington, MA: Jones & Bartlett Learning.