Cellulitis
One of the most frequent problems of an aesthetic nature that we Dermatologists deal with in our offices during this period of time is the fight against cellulite and the treatment of stretch marks, in order for patients to prepare their appearance for the summer season in time and with the best possible result.
But what is cellulite?
It is an aesthetic deformity, a multifactorial disease that occurs in both sexes but with a much greater frequency in women. It is estimated that 84-98% of women will develop symptoms after puberty. It is due to the uneven distribution of fat cells and the contraction of the subcutaneous connective tissue giving the affected area the appearance of an orange peel full of ‘dimples’.
Although due to its increased incidence, which makes it seem normal since it is the rule and not the exception, the aesthetic effect and the trends of our time are increasingly pushing women to deal with this problem.
As it is not a pathological condition, it is often treated and presented as a common aesthetic disfigurement unworthy of scientific attention, allowing the sophisticated to prosper at the expense of consumers.
For this reason it is important to turn to the right medical specialty which is only Dermatologists. Despite the fact that its causes are many, today there are four main theories on the etiology of cellulite.
Epigrammatically:
- Anatomical theory (different anatomy of subcutaneous fat in men than women that also explains the prevalence of the disease in the female sex)
- Theory of microcirculation disorder (fluid retention)
- Theory of inflammation (connective tissue development and fibroplasia)
- Iron toxicity theory (lipid peroxidation causes inflammation)
There are predisposing factors and they are:
- Gender (anatomical differences between the sexes, increases during pregnancy, menstruation, taking estrogen)
- Race, It is more common in Caucasians and rarer in Latinas
- Distribution of adipose tissue (usually where there is fat deposition. It also occurs in thin people, not directly related to obesity but…)
- Nutrition (the increased intake of carbohydrates + fat causes hyperinsulinemia and lipogenesis. Salt abuse causes fluid retention. A diet poor in fiber causes constipation, resulting in an increase in venous pressure in the lower extremities. This leads to venous stasis and increased capillary permeability resulting in edema
- Alcohol consumption causes an increase in lipogenesis.
- Smoking causes microcirculation alterations, reduces tissue perfusion and increases free radicals
- Lack of physical exercise, as is well known, causes an increase in adipose tissue, and venous stasis.
- Hormonal dysfunction, taking hormonal preparations (estro-progestogens) (contraceptives, nutritional supplements, food preservatives, etc.), cause fluid retention
- Stress (anxiety, depression). There are four receptors in fat cells, 3 promote lipolysis, the 4th suppresses it. Epinephrine binds to these receptors suppressing lipolysis in subcutaneous tissue while promoting it in visceral adipose tissue.
Cellulite has several stages and several classifications have been proposed. The two most prevalent are:
A) Cellulitis histological progression. It was proposed by Curri et al in 1991
- Stage I (Latent Cellulitis Stage): Absence of clinical findings of mattress effect
- Stage II: Pale and cold skin when the areas in question are tightened or pressed.
- Stage III: Skin with orange peel appearance, deep granulomas, pain, elasticity, pale + cold skin.
- Stage IV: More uneven skin surface, painful subcutaneous nodules.
B) Classification according to skin texture was proposed by Bartoletti et al in 1983
- Hard / Inferior Cellulite (in teenage girls and women who exercise)
- Relaxed (muscle relaxation, large and sudden loss of BP, > 40 years.
- Tumorous
- Mixed
How is it treated?
There are many therapeutic methods for dealing with cellulite such as:
- Mesotherapy
- Light energy sources such as laser (LASER) and pulsed light (IPL)
- Radio frequencies
- The lymphatic massage
- The nutrition
- The exercise
- Dealing with stress
- CARBOXY THERAPY
- Ultrasound shock wave therapy
- The detachment of the dips
- The multiple microneedling of the skin (MICRONEEDELING)
- Combinations of the above treatments
The treatment of cellulite in order to be effective must ‘target’ the causes and the pathogenic mechanism that have caused it. Therefore, after a correct diagnosis, evaluation and classification of the stage of cellulite has been made, the treatment is then selected. I personally believe that the maximum efficiency is achieved by combining some of the aforementioned methods.
Streaks
Streaks, popularly known as stretch marks, are gram-like atrophic lesions that are red in color initially when they are established and then in six to nine months acquire a white color (due to the lack of connective tissue).
They appear in both sexes mainly during adolescence. Essentially, striae is an atrophic area in the deepest layer of the skin, the dermis. It is mainly due to excessive skin tension (sudden increase in height, volume and body weight).
More often they are symmetrical and the areas that are usually found are the buttocks, thighs (especially on the inner and outer surfaces), knees (front and back surface), loins (waist), armpits while in women they also appear on the breasts as well as on the abdomen (after pregnancy).
What are the causes?
Virtually any condition excessively increases skin tension. It can also be due to medications as well as various ailments So, in short:
- Puberty (sudden increase in height, weight, volume)
- Changes in body weight
- Pregnancy (eight out of ten women experience stretch marks)
- After long-term oral cortisone treatment
- In Cushing’s syndrome
- Heredity
Are they treated?
In the initial stages when they are red with the right therapeutic approach they are 100% curable!!! But things get difficult as the streaks discolor and when they turn white there is no effective treatment. They are now permanent. Therefore, the early diagnosis and treatment of stretch marks while they are red is of key importance since in this case they disappear, while in white ones the techniques used are to make them as less visible as possible.
What treatments are applied?
A) In red:
- Pulsed Dye Laser (super responsive)
- Fractional Laser fractional dermabrasion (very good response)
- PRP growth factors (as monotherapy sub-moderate response)
- Micro-nimble (Moderate response)
- Mesotherapy (Satisfactory response)
Usually reds need three to five monthly sessions.
B) For white spots, the treatments used aim not to eliminate them but to make them as less visible as possible.
These are:
- Fractional Laser fractional dermabrasion (moderate response as monotherapy)
- Nd:YAG Laser (poor response as monotherapy)
- PRP growth factors (poor response as monotherapy)
- Minor drowsiness (Poor to moderate response as monotherapy)
- Mesotherapy (Poor response as monotherapy)
Whites need five to eight monthly sessions.
The combination of therapeutic approaches has much better results on whites as well as on reds. Depending on the extent and stage of the striae, the Dermatologist decides the best treatment strategy for his/her patient.