Cellulite

Cellulite

Overview
Cellulite is a topographic skin
Human skin
The human skin is the outer covering of the body. In humans, it is the largest organ of the integumentary system. The skin has multiple layers of ectodermal tissue and guards the underlying muscles, bones, ligaments and internal organs. Human skin is similar to that of most other mammals,...

 change that occurs in most postpubertal females. It presents as a modification of skin topography evident by skin dimpling and nodularity that occurs mainly in women on the pelvic region, lower limbs
Human leg
The human leg is the entire lower extremity or limb of the human body, including the foot, thigh and even the hip or gluteal region; however, the precise definition in human anatomy refers only to the section of the lower limb extending from the knee to the ankle.Legs are used for standing,...

, and abdomen
Abdomen
In vertebrates such as mammals the abdomen constitutes the part of the body between the thorax and pelvis. The region enclosed by the abdomen is termed the abdominal cavity...

, and is caused by the herniation
Hernia
A hernia is the protrusion of an organ or the fascia of an organ through the wall of the cavity that normally contains it. A hiatal hernia occurs when the stomach protrudes into the mediastinum through the esophageal opening in the diaphragm....

 of subcutaneous fat
Adipose tissue
In histology, adipose tissue or body fat or fat depot or just fat is loose connective tissue composed of adipocytes. It is technically composed of roughly only 80% fat; fat in its solitary state exists in the liver and muscles. Adipose tissue is derived from lipoblasts...

 within fibrous connective tissue
Connective tissue
"Connective tissue" is a fibrous tissue. It is one of the four traditional classes of tissues . Connective Tissue is found throughout the body.In fact the whole framework of the skeleton and the different specialized connective tissues from the crown of the head to the toes determine the form of...

, leading to a padded or orange peel–like appearance. Cellulite is a description rather than a physical object.
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Encyclopedia
Cellulite is a topographic skin
Human skin
The human skin is the outer covering of the body. In humans, it is the largest organ of the integumentary system. The skin has multiple layers of ectodermal tissue and guards the underlying muscles, bones, ligaments and internal organs. Human skin is similar to that of most other mammals,...

 change that occurs in most postpubertal females. It presents as a modification of skin topography evident by skin dimpling and nodularity that occurs mainly in women on the pelvic region, lower limbs
Human leg
The human leg is the entire lower extremity or limb of the human body, including the foot, thigh and even the hip or gluteal region; however, the precise definition in human anatomy refers only to the section of the lower limb extending from the knee to the ankle.Legs are used for standing,...

, and abdomen
Abdomen
In vertebrates such as mammals the abdomen constitutes the part of the body between the thorax and pelvis. The region enclosed by the abdomen is termed the abdominal cavity...

, and is caused by the herniation
Hernia
A hernia is the protrusion of an organ or the fascia of an organ through the wall of the cavity that normally contains it. A hiatal hernia occurs when the stomach protrudes into the mediastinum through the esophageal opening in the diaphragm....

 of subcutaneous fat
Adipose tissue
In histology, adipose tissue or body fat or fat depot or just fat is loose connective tissue composed of adipocytes. It is technically composed of roughly only 80% fat; fat in its solitary state exists in the liver and muscles. Adipose tissue is derived from lipoblasts...

 within fibrous connective tissue
Connective tissue
"Connective tissue" is a fibrous tissue. It is one of the four traditional classes of tissues . Connective Tissue is found throughout the body.In fact the whole framework of the skeleton and the different specialized connective tissues from the crown of the head to the toes determine the form of...

, leading to a padded or orange peel–like appearance. Cellulite is a description rather than a physical object. The term was first used in the 1920s, 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." Its existence as a real disorder has been questioned, and the prevailing medical opinion is that it is merely the "normal condition of many women". 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".

Synonyms include: adiposis edematosa, dermopanniculosis deformans, status protrusus cutis, and gynoid lipodystrophy. Descriptive names for cellulite include orange peel
Orange (fruit)
An orange—specifically, the sweet orange—is the citrus Citrus × sinensis and its fruit. It is the most commonly grown tree fruit in the world....

 syndrome, and cottage cheese
Cottage cheese
Cottage cheese is a cheese curd product with a mild flavor. It is drained, but not pressed, so some whey remains and the individual curds remain loose. The curd is usually washed to remove acidity, giving sweet curd cheese. It is not aged or colored. Different styles of cottage cheese are made from...

 skin.

Epidemiology


Cellulite is thought to occur in 80-90% of postpubertal females. There appears to be a hormonal component to its presentation. It is rarely seen in males, but is more common in males with androgen-deficient states, such as Klinefelter's syndrome
Klinefelter's syndrome
Klinefelter syndrome, 46/47, XXY, or XXY syndrome is a condition in which human males have an extra X chromosome. While females have an XX chromosomal makeup, and males an XY, affected individuals have at least two X chromosomes and at least one Y chromosome...

, 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.

Causes


The causes of cellulite involve changes in metabolism
Metabolism
Metabolism is the set of chemical reactions that happen in the cells of living organisms to sustain life. These processes allow organisms to grow and reproduce, maintain their structures, and respond to their environments. Metabolism is usually divided into two categories...

 physiology
Physiology
Physiology is the science of the function of living systems. This includes how organisms, organ systems, organs, cells, and bio-molecules carry out the chemical or physical functions that exist in a living system. The highest honor awarded in physiology is the Nobel Prize in Physiology or...

 and dieting too hard or too much, such as gender-specific dimorphic skin architecture, alteration of connective tissue
Connective tissue
"Connective tissue" is a fibrous tissue. It is one of the four traditional classes of tissues . Connective Tissue is found throughout the body.In fact the whole framework of the skeleton and the different specialized connective tissues from the crown of the head to the toes determine the form of...

 structure, hormonal factors, genetic
Genetics
Genetics , a discipline of biology, is the science of genes, heredity, and variation in living organisms....

 factors, the microcirculatory system, the extracellular matrix
Extracellular matrix
In biology, the extracellular matrix is the extracellular part of animal tissue that usually provides structural support to the animal cells in addition to performing various other important functions. The extracellular matrix is the defining feature of connective tissue in animals.Extracellular...

, and subtle inflammatory
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...

 alterations.

Hormonal factors
Hormones play a dominant role in the formation of cellulite. Estrogen
Estrogen
Estrogens , oestrogens , or œstrogens, are a group of compounds named for their importance in the estrous cycle of humans and other animals. They are the primary female sex hormones. Natural estrogens are steroid hormones, while some synthetic ones are non-steroidal...

 may be the important hormone to initiate and aggravate cellulite. However, there has been no reliable clinical evidence to support such a claim. Other hormones, including insulin
Insulin
Insulin is a hormone central to regulating carbohydrate and fat metabolism in the body. Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle....

, the catecholamines adrenaline and noradrenaline, thyroid hormone
Thyroid hormone
The thyroid hormones, thyroxine and triiodothyronine , are tyrosine-based hormones produced by the thyroid gland primarily responsible for regulation of metabolism. An important component in the synthesis of thyroid hormones is iodine. The major form of thyroid hormone in the blood is thyroxine ,...

s, and prolactin
Prolactin
Prolactin also known as luteotropic hormone is a protein that in humans is encoded by the PRL gene.Prolactin is a peptide hormone discovered by Henry Friesen...

, are all believed to participate in the development of cellulite.

Genetic factors
There is a genetic element in individual susceptibility to cellulite. Researchers led by Dr. Enzo Emanuele
Enzo Emanuele
Enzo Emanuele is an Italian clinical pathologist renowned for his interdisciplinary research in the field of biological psychology. He has studied the biochemical basis of romantic interpersonal attraction and identified the neurotrophin nerve growth factor as a key biochemical mediator of...

 have traced the genetic component of cellulite to particular polymorphisms
Single nucleotide polymorphism
A single-nucleotide polymorphism is a DNA sequence variation occurring when a single nucleotide — A, T, C or G — in the genome differs between members of a biological species or paired chromosomes in an individual...

 in the angiotensin converting enzyme (ACE) and hypoxia-inducible factor 1A
HIF1A
Hypoxia-inducible factor 1, alpha subunit , also known as HIF1A, is a protein that in humans is encoded by the HIF1A gene...

 (HIF1a
HIF1A
Hypoxia-inducible factor 1, alpha subunit , also known as HIF1A, is a protein that in humans is encoded by the HIF1A gene...

) genes.

Predisposing factors
Several factors have been shown to affect the development of cellulite. Gender
Gender
Gender is a range of characteristics used to distinguish between males and females, particularly in the cases of men and women and the masculine and feminine attributes assigned to them. Depending on the context, the discriminating characteristics vary from sex to social role to gender identity...

, race, biotype, distribution of subcutaneous fat, and predisposition
Predisposition
Predisposition may refer to:* Genetic predisposition, a genetic effect which can identify individuals who may be predisposed to certain health problems* Predispositioning Theory, mathematical term in the field of decision theory...

 to lymphatic and circulatory insufficiency have all been shown to contribute to cellulite.

Diet
Improving one's diet, combined with exercise, can improve the appearance of cellulite.

Lifestyle
A high stress
Stress (medicine)
Stress is a term in psychology and biology, borrowed from physics and engineering and first used in the biological context in the 1930s, which has in more recent decades become commonly used in popular parlance...

 lifestyle will cause an increase in the level of catecholamines, which have also been associated with the evolution of cellulite.

Treatment


Numerous therapies for the treatment of cellulite are available, but empirical evidence for the efficacy of these strategies is limited. In an interview with the New York Times, Dr. Molly Wanner, an instructor in dermatology
Dermatology
Dermatology is the branch of medicine dealing with the skin and its diseases, a unique specialty with both medical and surgical aspects. A dermatologist takes care of diseases, in the widest sense, and some cosmetic problems of the skin, scalp, hair, and nails....

 at Harvard Medical School
Harvard Medical School
Harvard Medical School is the graduate medical school of Harvard University. It is located in the Longwood Medical Area of the Mission Hill neighborhood of Boston, Massachusetts....

 and an author of a 2008 evidence-based review of existing treatments, asserted: “At this point, there is no outstanding treatment for cellulite.”

Dr. Michael F. McGuire, a clinical associate professor at the David Geffen School of Medicine at the University of California
University of California
The University of California is a public university system in the U.S. state of California. Under the California Master Plan for Higher Education, the University of California is a part of the state's three-tier public higher education system, which also includes the California State University...

, Los Angeles
Los Ángeles
Los Ángeles is the capital of the province of Biobío, in the commune of the same name, in Region VIII , in the center-south of Chile. It is located between the Laja and Biobío rivers. The population is 123,445 inhabitants...

, confirmed “realistically, there is no cure for cellulite.”.