Cellulite

Cellulite is the herniation of subcutaneous fat within fibrous connective tissue that manifests topographically as skin dimpling and nodularity, often on the pelvic region (specifically the buttocks), lower limbs, and abdomen.[1][2] Cellulite occurs in most postpubescent females.[3] A review gives a prevalence of 85 to 98% of women,[4] indicating that it is physiologic rather than pathologic. It can result from a complex combination of factors ranging from hormones to heredity.

Not to be confused with Cellulitis or Celluloid.
Cellulite
Other namesAdiposis edematosa, dermopanniculosis deformans, status protrusus cutis, gynoid lipodystrophy, orange peel syndrome
The dimpled appearance of cellulite
SpecialtyPlastic surgery

Causes

The causes of cellulite[5] include changes in metabolism, physiology, diet and exercise habits, obesity, sex-specific dimorphic skin architecture, alteration of connective tissue structure, hormonal factors, genetic factors, the microcirculatory system, the extracellular matrix, and subtle inflammatory alterations.[1][3][5][6]

Hormonal factors

Hormones play a dominant role in the formation of cellulite. Estrogen may be the important hormone in the development of cellulite. However, there has been no reliable clinical evidence to support such a claim. Other hormones, including insulin, the catecholamines adrenaline and noradrenaline, thyroid hormones, and prolactin, are all believed to participate in the development of cellulite.[1]

Genetic factors

There is a genetic element in individual susceptibility to cellulite.[1] Researchers led by Enzo Emanuele have traced the genetic component of cellulite to particular polymorphisms in the angiotensin converting enzyme (ACE) and hypoxia-inducible factor 1A (HIF1a) genes.[7]

Predisposing factors

Several factors have been shown to affect the development of cellulite. Sex, ethnicity, biotype, distribution of subcutaneous fat, and predisposition to lymphatic and circulatory insufficiency have all been shown to contribute to cellulite.[1]

Lifestyle

A high-stress lifestyle will cause an increase in the level of catecholamines, which have also been associated with the development of cellulite.[1]

Treatments

Cellulite is a multifactorial condition[8] and can be resistant to the array of treatments currently available. Aside from 'topical' products (creams, ointments, etc) and injectables (eg collagenase), treatments for cellulite include non-invasive therapy such as mechanical suction or mechanical massage. Energy-based devices include radio frequency with deep penetration of the skin, ultrasound,[9] laser and pulsed-light devices.[10][11] Combinations of mechanical treatments and energy-based procedures are widely used.[10] More invasive 'subcision' techniques utilise a needle-sized micro-scalpel to cut through the causative fibrous bands of connective tissue. Subcision procedures (manual, vacuum-assisted, or laser-assisted) are performed in specialist clinics with patients given local anaesthetic.[11]

Epidemiology

Cellulite is thought to occur in 80–90% of post-adolescent females.[7][12] There appears to be a hormonal component to its presentation. Its existence as a real disorder has been challenged[13] and the prevailing medical opinion is that it is merely the "normal condition of many women".[14] It is rarely seen in males,[1] but is more common in males with androgen-deficient states, such as Klinefelter's syndrome, hypogonadism, postcastration states and in those patients receiving estrogen therapy for prostate cancer. The cellulite becomes more severe as the androgen deficiency worsens in these males.

History

The term was first used in the 1920s by spa and beauty services to promote their services, and began appearing in English-language publications in the late 1960s, with the earliest reference in Vogue magazine, "Like a swift migrating fish, the word cellulite has suddenly crossed the Atlantic."[15]

References
  1. Rossi, Ana Beatris R; Vergnanini, Andre Luiz (2000). "Cellulite: A review". Journal of the European Academy of Dermatology and Venereology. 14 (4): 251–62. doi:10.1046/j.1468-3083.2000.00016.x. PMID 11204512.
  2. Pinna, K. (2007). Nutrition and diet therapy. Belmont, CA: Wadsworth. p. 178.
  3. Avram, Mathew M (2004). "Cellulite: A review of its physiology and treatment". Journal of Cosmetic and Laser Therapy. 6 (4): 181–5. CiteSeerX 10.1.1.506.7997. doi:10.1080/14764170410003057. PMID 16020201.
  4. Janda, K; Tomikowska, A (2014). "Cellulite - causes, prevention, treatment". Annales Academiae Medicae Stetinensis. 60 (1): 29–38. PMID 25518090.
  5. Pavicic, Tatjana; Borelli, Claudia; Korting, Hans Christian (2006). "Cellulite – das größte Hautproblem des Gesunden? Eine Annäherung" [Cellulite – the greatest skin problem in healthy people? An approach]. JDDG (in German). 4 (10): 861–70. doi:10.1111/j.1610-0387.2006.06041.x. PMID 17010177.
  6. Terranova, F.; Berardesca, E.; Maibach, H. (2006). "Cellulite: Nature and aetiopathogenesis". International Journal of Cosmetic Science. 28 (3): 157–67. doi:10.1111/j.1467-2494.2006.00316.x. PMID 18489272.
  7. Emanuele, E; Bertona, M; Geroldi, D (2010). "A multilocus candidate approach identifies ACE and HIF1A as susceptibility genes for cellulite". Journal of the European Academy of Dermatology and Venereology. 24 (8): 930–5. doi:10.1111/j.1468-3083.2009.03556.x. PMID 20059631.
  8. Rossi, Anthony M.; Katz, Bruce E. (2014). "A Modern Approach to the Treatment of Cellulite". Dermatologic Clinics. 32 (1): 51–9. doi:10.1016/j.det.2013.09.005. PMID 24267421.
  9. Juhász M, Korta D, Mesinkovska NA (2018). "A Review of the Use of Ultrasound for Skin Tightening, Body Contouring, and Cellulite Reduction in Dermatology". Dermatol Surg. 44 (7): 949–963. doi:10.1097/DSS.0000000000001551. PMID 29846343.
  10. Gold, Michael H. (2012). "Cellulite – an overview of non-invasive therapy with energy-based systems". JDDG. 10 (8): 553–8. doi:10.1111/j.1610-0387.2012.07950.x. PMID 22726640.
  11. Friedmann DP, Vick GL, Mishra V (2017). "Cellulite: a review with a focus on subcision". Clin Cosmet Investig Dermatol. 10: 17–23. doi:10.2147/CCID.S95830. PMC 5234561. PMID 28123311.
  12. Wanner, M; Avram, M (2008). "An evidence-based assessment of treatments for cellulite". Journal of Drugs in Dermatology. 7 (4): 341–5. PMID 18459514.
  13. Nürnberger, F.; Müller, G. (1978). "So-Called Cellulite: An Invented Disease". The Journal of Dermatologic Surgery and Oncology. 4 (3): 221–9. doi:10.1111/j.1524-4725.1978.tb00416.x. PMID 632386.
  14. MedlinePlus Encyclopedia Cellulite
  15. Vogue 15 Apr 1968 110/1

Further reading
  • Khan, Misbah H.; Victor, Frank; Rao, Babar; Sadick, Neil S. (2010). "Treatment of cellulite. Part I. Pathophysiology". Journal of the American Academy of Dermatology. 62 (3): 361–70, quiz 371–2. doi:10.1016/j.jaad.2009.10.042. PMID 20159304.
  • Khan, Misbah H.; Victor, Frank; Rao, Babar; Sadick, Neil S. (2010). "Treatment of cellulite. Part II. Advances and controversies". Journal of the American Academy of Dermatology. 62 (3): 373–84, quiz 385–6. doi:10.1016/j.jaad.2009.10.041. PMID 20159305.
Classification
External resources
  • Media related to Cellulite at Wikimedia Commons
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