Cellulite

From Wikipedia, the free encyclopedia

This article needs additional citations for verification. Please help improve this article by adding reliable references. Unsourced material may be challenged and removed. (May 2009)

Cellulite
Classification and external resources
The dimpled appearance of cellulite
MedlinePlus	002033

larger scale uneveness of the skin

Cellulite describes a condition that is claimed to occur in most women,^[1] where the skin of the lower limbs, abdomen, and pelvic region becomes dimpled after puberty.^[2] The term was first used in the 1920s and began appearing in English language publications in the late 1960s, the earliest reference in Vogue magazine, "Like a swift migrating fish the word cellulite has suddenly crossed the Atlantic."^[3] Its existence as a real disorder has been questioned,^[4] and the prevailing medical opinion is that it is merely the "normal condition of many women and some men".^[5] One cosmetic company has noted its historical place in industrialised societies as an "inappropriate term used by women to describe curves which they judge to be too plump and not very aesthetic".^[6]

Synonyms include: adiposis edematosa, dermopanniculosis deformans, status protrusus cutis, and gynoid lipodystrophy. Descriptive names for cellulite include orange peel syndrome, and cottage cheese skin.

[edit] Epidemiology

It is thought to occur in most women.^[7] There appears to be a hormonal component to its presentation. It is rarely seen in males,^[2] but is more common in males with androgen-deficient states such as Klinefelter's syndrome, hypogonadism, post-castration states and in those patients receiving oestrogen therapy for prostate cancer. The cellulite becomes more severe as the androgen deficiency worsens in these males.

[edit] Causes

The causes are poorly understood,^[8] and may involve changes in metabolism and physiology such as gender specific dimorphic skin architecture, alteration of connective tissue structure, vascular changes and inflammatory processes.^[1][2][8][9]

[edit] Hormonal factors

Hormones play a dominant role in the formation of cellulite. Although people^[who?] believe Estrogen is the most important hormone^{[citation needed]} and that it seems to initiate and aggravate cellulite^{[citation needed]}, 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.^[2]

[edit] Predisposing factors

Several genetic factors have been shown to be necessary for cellulite to develop. Gender, race, biotype,^[10] a hormone receptor allele that determines the receptor number and sensitivity, distribution of subcutaneous fat, and predisposition to circulatory insufficiency have all been shown to contribute to cellulite.^[2]

[edit] Diet

Dieting has shown to have variable effects on improving or worsening the apparent appearance of cellulite.^[11]

[edit] Lifestyle

Smoking, lack of exercise, fatty/starchy foods, and sitting or standing in a single position for long periods have all been correlated with an increase in cellulite^{[citation needed]}. A high stress lifestyle will cause an increase in the catecholamine hormones. ^[2]

[edit] Fashion

Within the last 40-50 years women went from loose underwear around the thighs to tight underwear going across the middle of the buttock.^{[citation needed]} Underwear that has tight elastic across the buttock limits blood flow, encouraging cellulite to form. Wearing thongs, boyshorts, or nothing and sleeping naked can reduce the impact underwear plays on cellulite's development.^{[citation needed]}

[edit] Treatment

Numerous therapies have been tried. There are no published reports in the scientific literature showing that any of these therapies work. In an interview with the New York Times, Dr. Molly Wanner, an instructor in dermatology at Harvard Medical School and an author of a 2008 evidence-based review of existing treatments, asserted, “At this point, there is no outstanding treatment for cellulite.”^[12] Dr. Michael F. McGuire, a clinical associate professor at the David Geffen School of Medicine at the University of California, Los Angeles, confirmed that “realistically there is no cure for cellulite.”^[13]

The most beneficial therapy may be to control lifestyle factors.^{[citation needed]} However, Dr. Jeffrey Dover, a director of SkinCare Physicians, a dermatology practice in Chestnut Hill, Mass., says, "Some people have misrepresented the truth to suggest that there’s a lot you can do.”^[14]

[edit] Physical and mechanical methods

Iontophoresis, ultrasound, thermotherapy, pressotherapy (pneumatic massaging in the direction of the circulation), lymphatic drainage (massage technique to stimulate lymphatic flow), electrolipophoresis (application of a low frequency electric current) have all been tried.^[2]

To administer a lymphatic drainage massage, the individual is positioned so that maximum exposure is given to the target area. Several slaps with the open palm are applied to the area for about two minutes, with occasional pauses to rub the area in a circular motion. The resulting heat, along with the vibration of the skin and rhythmic contractions of the gluteus muscles stimulates the draw of fluid into the capillaries.^{[citation needed]} The absorption of fatty acids and subsequent transport of fat causes the "orange peel" roughness to the skin to disappear.^{[citation needed]} This may take several sessions to accomplish. The massage can be effective not only with Grade 3 cellulite but can be used pro-actively for Grade 1 and 2.

However, these treatments have no proven results, and may only create short lasting effects.

[edit] Pharmacological agents

Any number of drugs that act on fatty tissue have been tried as therapeutic agents. Certain drugs act on the fatty tissue and connective tissue and on the microcirculation. They can be used topically,^[15] systemically, or transdermally.

These include the methyxanthines (theobromine, theophylline, aminophylline, caffeine), which act through phosphodiesterase inhibition, and pentoxifylline which improves micro-circulation; the adrenergic beta-agonists isoproterenol and adrenaline; the adrenergic alpha-antagonists yohimbine, piperoxan, phentolamine and dihydroergotamine; the methyIxanthine enhancers Coenzyme A and the amino acid l-carnitine; the drugs with connective tissue activity sillicium and Asiatic centella; the microcirculation active drugs Indian chestnut, ginkgo biloba, and rutin; and L-Carnitine.

These drugs are administered orally, as topically applied ointments, and by trans-dermal injection.

No independent scientific study or peer-reviewed literature has shown that pharmacological treatment has any significant effect on cellulite.

[edit] Compression garments

Clinical studies have found that compression garments, or shapewear garments, can help reduce the appearance of cellulite on the skin.^{[citation needed]}

[edit] Society and culture

While harmless, the dimpled appearance is a cause of concern for some people. The cosmetics industry claims to offer many of what it calls remedies. There are no supplements that have been approved as effective for reducing cellulite.

Radio frequency in the cosmetic industry is used to heat the skin in a non-invasive cosmetic procedure to heat the fat tissue underneath the skin. Other cosmetic procedures such as Mesotherapy have produced inconclusive results. While each has been FDA approved to reduce the appearance of cellulite temporarily, effectiveness varies by procedure. All methods require continual follow-up to maintain reduced levels of cellulite.

Liposuction, which extracts fat from under the skin, is not effective for cellulite reduction and may exacerbate the cosmetic problem. Dieting does not get rid of the dimpled appearance, but a balanced diet and exercise may help to reduce the fat content within the distorted cells, reducing their contribution to the dimpling.

[edit] References