Chapter 58: Cellulite

INTRODUCTION

Cellulite describes an orange peel type dimpling of skin in the upper posterior thighs and buttocks (Fig. 58.1). Although there is no associated morbidity or mortality, it is among the most common cosmetic complaints among female patients. It is present in nearly all postpubertal females, regardless of weight. It is best thought of as a female secondary sexual characteristic. Importantly, treatments for fat removal and cellulite should be considered distinct. Effective treatments for fat removal typically have no benefit for cellulite.

EPIDEMIOLOGY

Incidence: 85% to 98% of postpubertal females, far less common in males

Age: begins in females after puberty

Race: more common in Caucasians

Sex: far more common in females, rare in males

Precipitating factors: female gender, androgen deficiency in males (rare)

PATHOGENESIS

Unknown.

PHYSICAL LESIONS

There is an orange peel or cottage cheese type dimpling of the upper and outer thighs and buttocks. Other common locations include the breasts, lower abdomen, upper arms, and nape of neck.

DIFFERENTIAL DIAGNOSIS

None.

LABORATORY EXAMINATION

None indicated as the clinical appearance is classic.

COURSE

Begins in puberty in females and persists throughout life. In males with androgen deficiencies, the clinical appearance worsens as the androgen deficiency becomes more severe. It may present de novo in males undergoing hormonal therapy for prostate cancer.

KEY CONSULTATIVE QUESTIONS

In males, inquire as to any possibility of endocrine abnormalities. This is a very rare association of cellulite in males.

MANAGEMENT

There is no medical indication to treat cellulite. Still, many patients request therapy. Currently, there are numerous purported therapies, none of which have proven to be very effective. Interestingly, despite the lack of scientific evidence of improvement, many patients report subjective improvement and satisfaction with therapy.

TREATMENTS

Diet

• Weight has only a minor association with cellulite

• It is common in thin females and rare in obese males

• There is no data to show that diet and exercise are effective treatments

Topical Treatments

• Aminophylline, retinoids, lactic acid, xanthines, and many others have all been used with little evidence of efficacy

• Some creams may produce more harm than benefit

• In fact, one study indicated 25% of cellulite creams examined contained known contact allergens

Interventional Treatments

Liposuction

• There ...