Cellulite

Cellulite is known as the ‘Mattress phenomenon’ which displays pitting, bulging and deformation of skin; 90-98% of cases occur in women; feeling of tightness and heaviness in areas affected (particularly the legs); tenderness of skin when pinched, pressed upon, or vigorously massaged.

General considerations

Cellulite is a cosmetic defect which is a cause for great distress among millions of European and American women; no inflammatory or infectious process involved (as in cellulitis); better termed ‘dermo-panniculois deformans’ or ‘adiposis edematosa’.

Histological features

• Subcutaneous tissue of thighs has three layers of fat, with two planes of connective tissue (CT) (ground substance) between them; construction of subcutaneous tissue of thigh differs between men and women; in women, uppermost subcutaneous layer consists of ‘standing fat-cell chambers’, separated by radial and arching dividing walls of CT anchored to overlying CT of skin (corium); uppermost subcutaneous tissue in men is thinner, with network of criss-crossing CT walls and corium (CT structure between dermis and subcutaneous tissue) thicker than in women.

• ‘Pinch test’  = pinching skin and subcutaneous tissue of women’s thighs exhibits ‘mattress phenomenon’ – pitting, bulging, and deformation of skin; in most men, skin folds or furrows but will not bulge or pit.

• With aging, corium, already thinner in women than in men, becomes thinner and looser, fat cells migrate into this layer; CT walls between fat-cell chambers become thinner, allowing fat-cell chambers to hypertrophy; breakdown (thinning) of CT is a major contributor to cellulite and granular ‘buckshot’ feel of cellulite.

• ‘Mattress phenomenon’ = alternating depressions and protrusions in upper compartment of fat tissue; vertical orientation of women’s fat-cell compartments and weakening of tissues allow protrusion of fat cells into lower corium.

• Distension of lymphatic vessels of upper corium and decrease in number of subepidermal elastic fibers.

Clinical features

Areas of body involved are the gluteal and thigh regions, lower abdomen, nape of neck, and upper arms – areas affected in gynecoid (female) obesity.

Four major stages

• •Stage 0 – skin on thighs and buttocks has smooth surface when subject is standing or lying; pinch test – skin folds and furrows, but does not pit or bulge’ ‘normal’ stage of most men and slim women.
• • Stage 1 – skin surface smooth while standing or lying; pinch test clearly positive for mattress phenomenon (pitting, bulging, deformity of affected areas); normal for most females; in a male there may be a sign of deficiency of androgenic hormones; best classification most can expect, due to structural predisposition.
• • Stage 2 – skin surface smooth while lying, but when standing there is pitting, bulging, and deformity of affected skin; common in women who are obese or over 35-40 years of age.
• • Stage 3 – mattress phenomenon when lying or standing; very common after menopause and in obesity.

Therapeutic considerations

At ICIM Medics the best approach is prevention; number and size of fat cells largely determined by maternal prenatal nutritional status = significant predisposition; maintain slim subcutaneous fat layer via exercise and maintaining normal body weight throughout life (slim women and female athletes have little or no cellulite).

Lifestyle

ICIM Medics suggest patients to try implement the following into their lifestyles:
• Weight reduction and exercise: primary mode of treatment; weight reduction should be gradual, especially in women over age 40 – rapid weight loss may exacerbate mattress phenomenon.
• Massage: very beneficial, particularly self-administered with hand or brush; improves circulation of blood and lymph; direction of massage from periphery to heart.

Botanicals

Oral and topical herbs which enhance CT structures are recommended by ICIM.

• Centella asiatica: extract containing 70% triterpenic acids (Asiatic acid and asiatside) is orally effective treating cellulite, venous insufficiency of lower limbs, and varicose veins; normalises metabolism of CT – enhances tissue integrity by stimulating glycosaminoglycan (GAG) synthesis without promoting excess collagen synthesis or cell growth; GAGs are major components of amorphous intercellular matrix (ground substance) in which collagen fibers are embedded; net outcome = normal CT rich in GAGs; action in venous insufficiency and varicose veins = combination of CT effects and ability to improve blood flow through affected limbs.

• Escin: compound isolated from seeds of Aesculus hippocastanum (horse chestnut); anti-inflammatory and anti-edema properties; decreased capillary permeability by reducing number and size of small pores of capillary walls; venotonic – positive effect on varicose veins and thrombophlebitis; given orally, or escin/cholesterol complex applied topically; topical application of escin beneficial in treating bruises; decreases capillary fragility and swelling.

• Fucus vesiculosus (bladderwrack): seaweed used for obesity since 17th century; high iodine content may stimulate thyroid function; used in toiletries and cosmetics for soothing, softening, and toning effects;  topical application used to treat cellulite – has not been confirmed by scientific investigation, but soothing, softening, and toning effects may be beneficial.

•Cola species: rich source of caffeine and related compounds that potentiate effect of catecholamine-induced lipolysis; topical caffeine is preferable to oral cellulite, since effects will be primarily local.

Therapeutic approach

Cellulite is not a disease per se, but a cosmetic disorder due to tissue changes; excessive subcutaneous adipose or degeneration of subcutaneous CT leads to fat chamber enlargement and ‘mattress phenomenon’; reduce subcutaneous fat and enhance connective tissue integrity; varicose veins often coexist with cellulite-both conditions result largely from loss of integrity of supporting CT. ‘Mattress phenomenon’ in men is a sign of androgen deficiency-primary or secondary hypogonadism.

ICIM take the following therapeutic approach :

• Diet: high complex carbohydrates and low refined carbohydrates and fats; promote weight loss in obese patients.

• Physical measures:

• - exercise: 20-30 min aerobic exercise a minimum of 5 days/week
• - Massage: regular self-massage of affected area

• Botanical medicine
Oral administration

• - Centella asiatica extract
• - Aesculus hippocastanum, bark of root
• - Escin

Topical application of salve, ointment

• - cholesterol/escin complex
• - Cola vera extract
• - Fucus vesiculosus

For more information on this topic please call ICIM Medics on +353 45 844 819 or email us at info@icim.ie

Tags: Cellulite, Skin Conditions