Skin dimpling, often called peau d’orange (orange peel skin), describes small depressions or pits on the skin’s surface. It is a manifestation of changes in the underlying tissue, typically resulting when internal structures, such as connective tissue or fluid, cause the skin to be pulled or tethered downward. Dimpling can be caused by conditions ranging from benign to medically serious.
Defining Skin Dimpling and Its Common Forms
The distinctive texture of skin dimpling resembles the pitted surface of an orange peel. This visual effect occurs because the skin’s pores or hair follicles are anchored to deeper tissue layers by fibrous bands. When the surrounding tissue swells or thickens, the anchored points are held down, creating the pitted appearance across the raised surface.
The most frequent and harmless form of dimpling is cellulite, which affects a high percentage of post-pubertal women, primarily on the thighs, buttocks, and abdomen. Cellulite arises when subcutaneous fat cells push upward against the connective cords that anchor the skin, causing the surface to appear lumpy and dimpled. This cosmetic change involves fat lobules pushing against the fibrous septae.
Dimpling can also occur temporarily following a localized injury or trauma. In these cases, fat necrosis, the death of fatty tissue, can lead to the formation of a firm lump and subsequent dimpling of the overlying skin. This type of dimpling is usually a localized reaction to tissue damage and often resolves as the body heals. Scarring or rapid changes in body weight may also cause the skin to retract or pucker in a localized area.
Pathological Causes of Skin Dimpling
When dimpling appears in specific locations, particularly on the breast, it can signal a more serious underlying condition. One mechanism involves inflammation and infection, such as mastitis, which causes breast tissue swelling. The resulting fluid buildup (edema) causes the skin to swell and become pitted as the hair follicles remain anchored, producing a peau d’orange effect.
Certain autoimmune disorders affecting connective tissue can also lead to skin dimpling due to excessive collagen production. In scleroderma, the immune system triggers an overproduction of collagen, causing the skin and underlying tissues to become thickened and fibrous. This process can result in a diffuse, irregular peau d’orange appearance, especially on the lower limbs, as the thickened tissue compresses and pulls on the skin.
The most concerning cause of new-onset dimpling is malignancy, specifically certain types of breast cancer. Inflammatory Breast Cancer (IBC), a rare but aggressive form, frequently presents with a prominent peau d’orange texture. This occurs because cancer cells infiltrate and block the lymphatic vessels in the skin, leading to a rapid accumulation of lymph fluid and subsequent swelling and pitting.
Other breast cancers, such as invasive ductal carcinoma, can cause localized dimpling through skin tethering. A tumor growing deeper within the breast tissue pulls on the Cooper’s ligaments, the fibrous structures that support the breast and connect to the skin. This pulling action causes the skin to visibly retract or pucker in a single, distinct area.
When to Seek Medical Evaluation
Any new or unexplained instance of skin dimpling, particularly if localized and persistent, warrants a prompt medical evaluation. Dimpling on the breast is a red flag, especially if it appears suddenly or affects only one side. Other concerning signs that prompt immediate attention include pain, tenderness, persistent redness, warmth, or noticeable swelling of the affected area.
Systemic symptoms can also indicate a serious underlying condition, such as unexplained fever, fatigue, or rapid, unintentional weight loss. If the dimpling is accompanied by nipple discharge or a recently inverted nipple, consult a healthcare provider without delay.
A medical evaluation typically begins with a thorough physical examination and a detailed review of the patient’s medical history. If dimpling is noted, a doctor may order various diagnostic tests to determine the cause. Common imaging tools include an ultrasound, which visualizes underlying soft tissues, and a mammogram, which provides a detailed X-ray of breast tissue. Depending on these initial findings, a biopsy may be necessary to confirm a definitive diagnosis.