Peau d’orange

Renaissance oil paintings depicted voluptuous women baring their all, cellulite included. The word itself was coined in the 1920s by French doctors, and began appearing in English language publications in the late 1960s, with the earliest reference in Vogue magazine in 1968.  By the late 1970s, cellulite was well-known in women’s circles. But in the medical community is was “so-called cellulite: an invented disease.” Today, whether cellulite is a real disease or only a disturbing aesthetic issue is still a matter of controversy. But make no mistake, whether in England, a mattress pad; France, an orange peel; or America, cottage cheese – cellulite certainly exists (pathological or not).

Cellulite is traditionally considered a highly prevalent aesthetic condition in women. It describes the herniation of subcutaneous adipose (fat) tissue through the net-like fibrous connective tissue that manifests topographically as skin dimpling. Cellulite does not differ from “normal” fat, it differs only in the way it is held and distributed in the body tissues. The actual chemical nature of the fat is not different from other body fat. However, its presence often mars our areas of highest adipose deposition: buttocks, lower limbs, and abdomen. We can thank our mothers and grandmothers for the distribution of body fat as it is often genetically determined, thereby theoretically linking cellulite to genetics. And for more bad news: as we age, the mesh network of connective tissue between our skin and muscle, which used to stretch to accommodate weight fluctuations, become inflexible increasing the amount and severity of cellulite. But before you start mirror-gazing and wistful thinking, know that cellulite does not need any treatment because it does not technically represent a true disease of the skin. Not pretty, but not pathological.

While most studies published to date claim that cellulite may affect up to 80-90% of postpubertal women there is a paucity of published epidemiological data on the exact prevalence and incidence of this condition. The association of cellulite with age, smoking, estrogen use, poor physical activity, body mass index, and indexes of cardiac risk has been repeatedly suggested in an anecdotal fashion but it has never been proven by strong epidemiological data.

And yet, despite its seemingly ubiquitous and harmless existence women spend millions of dollars every year on cellulite products, a projected $62 million dollars in 2013. As far as anti-cellulite treatments go, the possibilities are endless: there’s electric currents; injections; pulverization by rollers, suction pads and all manner of other implements; space-age pods; seaweed and clingfilm wraps; liposuction; laser; ultrasound. Don’t forget the anti-cellulite tea, caffeine-loaded patches, unmentionables that massage-away the cellulite; and you can even wear tights with capsules in them which promise to “stimulate the breakdown of fatty tissue” … just to name a few.

But the real question is, does any of it work? And the evidence-based, short answer, no.

There is no cure for cellulite. A lasting remedy would have to address the interplay between skin, fat, connective tissue and underlying muscle. In other words, curing cellulite requires nothing short of changing the structure of skin. However, it seems clear from market trends that there is considerable commercial interest in developing effective strategies aimed at reducing the cottage-cheese–like appearance of cellulite areas. But a majority of cellulite treatments fall short of their claims. Quite disturbingly, the majority of treatment attempts to date have been conducted in an empirical manner and without the application of rigorous scientific methodology. So far, insufficient data exist to provide an accurate assessment of the quality, efficacy, and safety of most cellulite remedies. More stringent regulatory control is needed over commercial products aiming at improving the appearance of cellulite, especially given their expanding market volume.

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