Cellulite and its treatment

Synopsis The presence of cellulite is an aesthetically unacceptable cosmetic problem for most post‐adolescent women. It is largely observed in the gluteal‐fermoral regions with its ‘orange‐peel’ or ‘cottage cheese’ appearance. It is not specific to overweight women although increased adipogenicity will exacerbate the condition. It is a complex problem involving the microcirculatory system and lymphatics, the extracellular matrix and the presence of excess subcutaneous fat that bulges into the dermis. It has been described as a normal condition that maximizes subcutaneous fat retention to ensure adequate caloric availability for pregnancy and lactation. Differences in the fibrous septae architecture that compartmentalize the adipose tissue have recently been reported in women with cellulite compared with men. Weight loss has been reported to improve the cellulite severity by surface topography measures although in obese subject's skin dimpling does not seem to change appreciably. However, histological analysis suggests that fat globules retract out of the dermis with weight loss. Cellulite has been treated with massage which decreases tissue oedema but it is also likely to have its effects at the cellular level by stimulating fibroblast (and keratinocyte) activity while decreasing adipocyte activity. In addition to massage, effective topical creams with a variety of agents were used to ameliorate the condition. Nevertheless, only a few studies are reported in the scientific literature. Xanthines, botanicals, fragrances and ligands for the retinoid and peroxisomal proliferator‐activated receptors appear to be giving some benefit. Reducing adipogenesis and increasing thermogenesis appear to be primary routes and also improving the microcirculation and collagen synthesis. Many agents are being investigated for weight management in the supplement industry [hydroxycitrate, epigallocatechin gallate, conjugated linoleic acid (CLA), etc.] and some of these agents seem to be beneficial for the treatment of cellulite. In fact, CLA was proven to ameliorate the signs of cellulite. One product, Cellasene, containing a variety of botanicals and polyunsaturated fatty acids also appears to provide some relief from these symptoms. Although more work is needed, clearly these treatments do improve the appearance of skin in subjects with cellulite. It is quite possible, however, that synergies between both oral and topical routes may be the best intervention to ameliorate the signs and symptoms of cellulite.