Cellulite histopathology and related mechanobiology

Machine Learning Decision Support for Bedside Ultrasound to Detect Lipohypertrophy

BACKGROUND

The most common dermatological complication of insulin therapy is lipohypertrophy.

OBJECTIVE

As a proof-of-concept, we built and tested an automated model using a convolutional neural network (CNN) to detect the presence of lipohypertrophy in ultrasound images.

METHODS

Ultrasound images were obtained in a blinded fashion using a portable GE LOGIQe machine with an L8-18i-D probe (5-18 MHz; GE Healthcare, Frankfurt, Germany). The data was split into train, validation and test splits of 70%, 15%, and 15% respectively. Given the small size of the dataset, image augmentation techniques were used to expand the size of the training set and improve the model's generalizability. To compare the performance of the different architectures, the team considered the accuracy and recall of the models when tested on our test set.

RESULTS

The DenseNet CNN architecture was found to have the highest accuracy (76%) and recall (76%) in detecting lipohypertrophy in ultrasound images, when compared to other CNN architectures. Additional work showed that the YOLOv5m object detection model could be used to help identify the approximate location of lipohypertrophy in ultrasound images identified as containing lipohypertrophy by the DenseNet CNN.

CONCLUSIONS

We were able to demonstrate the ability of machine learning approaches to automate the process of detecting and locating lipohypertrophy.

CLINICALTRIAL

Cellulite: Presentation and Management

Cellulite is a common dermatological condition with a female preponderance, affecting up to 90% post-pubertal females. It is characterized with dimpling and denting of the skin surface, giving it a Peau d'orange appearance. Once considered to be a benign physiological isolated skin condition of only an aesthetic concern, cellulite is now considered a pathological entity with systemic associations and a negative psychological impact on patients. Several treatment options from lifestyle modifications, topical cosmetic therapies to energy-based devices have been studied for its treatment. However, treatment remains a challenge despite many new modalities in the armamentarium. Laser and light therapies along with radiofrequency are useful treatment options with good safety profile. Acoustic wave therapy, subcision, and 1440-nm Nd:YAG minimally invasive laser are beneficial in cellulite reduction. Methodological differences in the trials conducted, makes it difficult to compare different treatment modalities. Overall, treatment needs to be individualized based on the patient characteristics and severity of the condition. Combination of treatments is often required in most patients for reducing cellulite.

Prevalence and factors associated with gynoid lipodystrophy in Brazilian adolescent girls: a cross-sectional study

BACKGROUND

Gynoid lipodystrophy (GLD), or female cellulitis, is a chronic multifactorial disorder characterized by the irregular appearance of the skin surface on the thighs and gluteal regions, which affects 80-90% of women after puberty. No curative treatments are available, and there is a paucity of epidemiological studies related to its prevalence, quality of life impact, and risk factors. We aimed to identify the prevalence and factors associated with the development of GLD in Brazilian adolescent girls.

METHODS

A cross-sectional study examined adolescent girls from São Paulo, Brazil. The explored factors were grouped: familial history, gynecological and hormonal characteristics, exercise practice, nutrition and diet, anthropometric measures, body mass index, and body composition, according to GLD severity assessed through multivariate hierarchic statistics.

RESULTS

In total, 184 girls, aged from 12 to 18 years, were included in the study. The overall prevalence of GLD was 77.7% (CI 95% 71.7-82.1%); moderate and severe categories of GLD occurred in 56.5% (CI 95% 48.9-62.5%) of the sample. An impact on the quality of life was identified in 39.7% of the girls. GLD was independently associated with higher body mass index, early menarche, higher carbohydrate intake, lower water consumption, menstrual irregularity, familial report of GLD, and less exercise practice.

CONCLUSION

Gynoid lipodystrophy is a multifactorial disorder; its onset in adolescent girls is associated with familial occurrence, body composition, diet habits, exercise, and hormonal factors. These results support further interventions for GLD prevention and treatment.

Considerations on zero-degree cellulite

Cellulite affects almost all women, and it is characterized by surface relief alterations, mainly located on the thighs and buttocks, and other areas. Whereas depressed lesions occur due to the presence of thick subcutaneous fibrous septa that pull the skin surface down, raised areas result from the projection of underlying fat to the skin surface. We support that the absence of cellulite can be defined as the ideal balance between the mechanical forces that act between the subcutaneous structures, such as fat and fibrous septa and muscles, and the overlying skin.

Objective and subjective reduction of cellulite volume using a localized vibrational massage device in a 24-week randomized intra-individual single-blind regression study

Cellulite occurs in females and is a common condition of altered connective tissue matrix and increased adipogenicity with visible dimples and orange‐peel appearance on the skins surface. Whilst advancements in methods continue to help our understanding, attempts to correct the appearance of cellulite topically have yielded limited success. Various kinds of non‐invasive body contouring methods such as whole body vibration have been reported with demonstrable visible improvements in the cellulite condition. The aim of this study was to evaluate volume reduction and improvement of the visible appearance of cellulite as judged both objectively (AEVA‐HE phase‐shift 3‐D fringe projection, macrophotography image grading) and subjectively (questionnaires) after application of a hand‐held localized vibrational device over 24‐weeks. The study was conducted on 40 healthy female volunteers who were instructed how to use the device on defined areas of cellulite of the outside and rear of the thighs (iliotibial band, and over biceps femoris region respectively). The initial 12 weeks of continuous massage application of the study were followed by a 12 week phase in which volunteers were split into 2 subgroups – one for assessment of regression effects and one for continuous application effects. AEVA (skin surface volume) measurements of cellulite‐related dimples correlated with questionnaires and visual image evaluation scoring, in that in the iliotibial region cellulite was significantly reduced at 12 weeks. In the regression subgroup cellulite returned to initial values soon after cessation of treatment, whereas in the continuous application subgroup, cellulite remained diminished. The effect of this device to reduce cellulite as observed in this study proves that continuous use of vibrational massage is beneficial to mitigate visible signs of cellulite.

Treatment for cellulite

Cellulite is a multifactorial condition that is present in 80% to 90% of postpubertal women and is one of the most intolerable esthetic imperfections. There are several theories on the pathophysiology of cellulite, and a number of different therapeutic regimens have been developed, from topical treatments to mechanical or energy-based devices. In this brief review, we summarize the scientific landscape to determine the clinical evidence with regard to the safety and efficacy of cellulite treatment options. Clinical protocols and the author’s experience using a combination of internal and external procedures are also discussed. Studies using laser and light modalities along with radiofrequency have shown improvements in cellulite and a good safety profile, but acoustic wave therapy, subcision, and the 1440-nm Nd:YAG minimally invasive laser have demonstrated the most beneficial results in cellulite reduction. Although there is paucity of scientific evidence for treatments that improve cellulite, future emerging options and their combination may pave the way to eradicate this primarily cosmetic esthetic concern.

Cellulite: A Surgical Treatment Approach

BACKGROUND

Cellulite is one of the most common skin and subcutaneous tissue conditions, affecting predominantly the thighs and hips in postadolescent women. Its etiology is not well defined, and multiple available treatments show variable efficacy.

OBJECTIVES

To describe a technique for treatment of cellulite of the gluteal region, thighs, and hips through superficial liposuction utilizing a special cannula, combined with subcutaneous autologous fat grafting.

METHODS

A retrospective review was performed of patients treated over 26 years at the Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil. Patients underwent pretreatment evaluation as to the extent of their cellulite, and pretreatment and posttreatment photographs were obtained for visual evaluation of the results.

RESULTS

Procedures were performed on 126 patients: 121 (96%) women and 5 (4%) men. The majority considered their results good or excellent. The complication rate was low, with the most common complications being ecchymosis, contour irregularities, partial recurrence of cellulite, seroma, and numbness.

CONCLUSIONS

We describe an effective method for the treatment of cellulite. Whereas subcision techniques utilize a needle or microblade to cut fibrous septa, we utilize a special cannula; larger areas can be treated than with subcision. Fat grafting is utilized to correct depressions and improve skin quality, which are added benefits compared to traditional subcision. Considering the multiple available cellulite treatments and their limitations, and the high patient satisfaction rate we achieved, with a low recurrence and complication rate, this technique can be a safe and effective option for patients with cellulite.

LEVEL OF EVIDENCE 4

Treatment of Dimpling from Cellulite

Background

Cellulite can be seen on the skin in widespread alterations of the skin surface and dimpling. The purpose of this study was to assess the effectiveness and safety of the manual subcision technique to treat dimpling from cellulite, using a specific class IIA medical device (Celluerase).

Methods

The multi-center observational study assessed 200 women treated in a single session for different dimpling, using manual subcision administered by Celluerase. Aesthetic outcomes were evaluated by the authors, and the patients assessed satisfaction levels.

Results

Two hundred women between 20 and 55 years were treated. The medical evaluation of patients saw improvements with an average score of 8.1, whereas the subjective evaluation by patients gave an average improvement score of 7.8. Adverse events were reported.

Discussion

Women have septa orientation at right angels to the skin surface, and those with cellulite have an irregular septa conformation, with some septa being hypertrophic-thickened, and others being narrowed-lysed. Magnetic resonance imaging has confirmed that cellulite depressions are associated with a significant increase of thickness of underlying subcutaneous fibrous septa. Subcision has immediate results because it eliminates traction on the skin.

Conclusion

The study has shown the effectiveness and safety of the manual subcision in the treatment of dimpling. The device used, designed specifically for this technique, has shown itself to be very helpful and effective in terms of practical use, aesthetic outcome and safety, with various advantages compared with other commonly used devices.

Correlação entre alinhamento pélvico e fibroedema geloide

RESUMO O fibroedema geloide (FEG) é uma desordem dos tecidos dérmico e subcutâneo. Acomete 90% das mulheres após a puberdade. Vários fatores predisponentes interferem na sua ocorrência, entre os quais as alterações posturais. Para avaliação da postura e do FEG, a fotogrametria tem se mostrado um recurso confiável, de fácil aplicação, reprodução e de baixo custo. Avaliou-se se há correlação entre alinhamento pélvico e FEG na região glútea por meio da fotogrametria. Estudo do tipo transversal observacional, com 46 mulheres de 18-29 anos (média 23 anos±4,2 anos). Foi realizada avaliação postural pelo software de avaliação postural (SAPO) e calculado o ângulo entre as espinhas ilíacas anteros superiores direita e esquerda. O FEG foi classificado de acordo com a escala fotonumérica de Hexsel. As análises foram realizadas por dois avaliadores independentes e cegos, e foi utilizado o teste de correlação de Pearson. Obteve-se como resultado o valor médio do ângulo de desalinhamento pélvico de 1,70 (±1,46), o valor médio do FEG no glúteo direito de 6,30 (±4,01) e no esquerdo de 6,76 (±3,61). Não foi observada correlação entre o alinhamento pélvico e o grau de FEG na região glútea (p=0,38).

Cellulite: a review with a focus on subcision

Cellulite is an alteration in skin topography most often found on the buttocks and posterolateral thighs of the majority of postpubertal females. This article aims to review the background, potential pathophysiology, and potential treatment options for cellulite, highlighting subcision as an ideal therapeutic option for this cosmetically distressing condition.

Longitudinal evaluation of manual lymphatic drainage for the treatment of gynoid lipodystrophy

BACKGROUND

The gynoidlypodystrophy, known as cellulitis or cellulite, refers to a condition that gives the skin an undulating and uneven appearance, affecting 80-90% of women after puberty.

OBJECTIVES

to investigate the efficacy and safety of manual lymphatic drainage for cellulite management.

METHODS

this was an open, prospective, intervention study including 20 women aged from 20 to 40 years. Fourteen sessions of manual lymphatic drainage were performed once a week on lower limbs and buttocks.

RESULTS

Fifteen women completed the study. A significant improvement on quality of life was observed (p=0.018). A significant reduction (p=0.023), estimated at 0.3±0.8 cm, in hip circumference was found, but no difference was found in thighs circumference (p>0.05). A significant reduction elastic recuperation of skin on buttocks, which means skin elasticity worsening, was observed. All measures obtained by ultrasound images showed no changes (p>0.05).

CONCLUSION

manual lymphatic drainage was safe but not effective as an isolated approach for cellulite management. Further randomized, controlled or comparative studies about manual lymphatic drainage for cellulite control, as unique or combined therapeutic modality, are necessary.

Cellulite: advances in treatment: facts and controversies

Cellulite is traditionally considered a highly prevalent aesthetic condition in women. From a clinical standpoint, it is characterized by a cottage-cheese-like appearance of the skin, which can be most commonly found in certain areas of the body (eg, thighs, buttocks, and legs). Although cellulite is generally asymptomatic, the more severe stages can be accompanied by the appearance of painful nodules and increased local temperature, which are suggestive of an inflammatory reaction occurring in the dermis and in the underlying subcutaneous adipose tissue. Whether cellulite is a real disease or only a disturbing aesthetic issue is still a matter of controversy. This debate notwithstanding, 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. Quite disturbingly, the majority of treatment attempts to date have been conducted in an empirical manner and without the application of rigorous scientific methodology. This is likely due--at least in part--to the lack of major, evidence-based pathophysiological insights into the nature of this condition. More stringent regulatory control is needed over commercial products aiming at improving the appearance of cellulite.

Single treatment of grades II and III cellulite using a minimally invasive 1,440-nm pulsed Nd:YAG laser and side-firing fiber: an institutional review board-approved study with a 24-month follow-up period

BACKGROUND

Cellulite represents one of the common topographic alterations to the skin surface and one of the structural changes to the subdermal fat and septal band of the posterolateral thighs. Currently, no treatment exists to address this entity with a multifactorial genesis that produces long-term beneficial outcomes. This clinical study evaluated the safety and efficacy of the 1,440-nm laser and the duration of the clinical benefits during 2 years.

METHODS

Initially, 25 healthy women with thigh cellulite were enrolled in this prospective institutional review board (IRB)-approved study. For grade II cellulite, the laser fiber delivered up to 1,000 J of energy to the undersurface of the entire involved skin. For grade III cellulite, the laser fiber distributed 1,300 to 1,500 J of energy to melt the subdermal fat, subcise the taut septal bands, and heat the reticular dermis. Baseline and posttreatment analyses included standardized high-resolution photography, skin elasticity measurements, ultrasound scanning for dermal thickness, histology, investigator global assessment scores, and recording of adverse events.

RESULTS

Of the 24 subjects who underwent treatment, only 20 were available for the 6-month follow-up assessment. Objective measurements at 2 years demonstrated an increase over the baseline mean skin elasticity (34 %) and mean dermal thickness (11 %), as well as an increase in the average percentage of dermal thickening determined by ultrasound imaging. Independent investigator global assessments were rated higher for grade II subjects than for grade III subjects throughout the 2-year follow-up period. Mild adverse events disappeared by the third month.

CONCLUSIONS

This IRB-conducted clinical trial, as part of a multicenter study for Food and Drug Administration approval, demonstrated the safety and efficacy of a single minimally invasive treatment for grades II and III thigh cellulite during a 2-year follow-up period.

LEVEL OF EVIDENCE II

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Cellulite's aetiology: a review

Cellulite, highly prevalent among women, represents a serious problem for many of them, and one of their main aesthetic concerns. It is difficult to pinpoint its aetiology and physiology/pathophysiology, as there are many factors that are involved in it, affect it, and many processes that are taking place simultaneously and sequentially. Our objective is therefore, to review the scientific scholarship on cellulite to explore the causes of its origin. We carried out a preliminary search of the Medline, Cochrane, and Web of Knowledge databases covering the period from 1978 to April 2011. As there is no specific key word for the phenomenon at hand, we used the following descriptors: adipose tissue, subcutaneous fat, subcutaneous tissue, connective tissue, skin, skin disease and dermis. This resulted in a retrieval of 26 articles contributing to relevant information on the aetiology of cellulite. As a result of our first research, we concluded that cellulite is a physiological phenomenon or at least, that it has a physiological origin, which is characteristic of women, and multi-causal, with the coexistence of a number of factors that trigger, perpetuate, or exacerbate it. The outstanding factors include, among others, connective tissue architecture, oestrogen action, microvascular alterations and certain genetic and hormonal characteristics. All of them provide us with future and novel clues to cellulite treatment, and is necessary to take some or all of these factors into account in developing an effective therapy. However, we are aware of the necessity of further investigation in this field.

Effect of cosmetic ingredients as anticellulite agents: synergistic action of actives with in vitro and in vivo efficacy

BACKGROUND

The pathophysiology of cellulite involves changes in the subcutaneous adipose layer and the extracellular matrix (ECM) that supports it together with overlying dermal layer. Cellular mechanisms governing cellulite are not fully understood. However, it is accepted that changes include enhanced lipogenesis, decreased lipolysis, and increased lipid storage within the adipocytes as well as changes in the dermal architecture.

AIM

In our studies the ability of cosmetic agents Furcellaria lumbricalis, Fucus vesiculosus, retinoid, conjugated linoleic acid (CLA), and a glaucine mixture to stimulate in vitro 1) lipolysis in human adipocytes and 2) production of pro-collagen I by fibroblasts was investigated in vitro. The ability of these ingredients to improve cellulite condition in vivo was also determined.

PATIENTS/METHODS

Mature adipocytes and 'aged' fibroblasts were used for in vitro studies. The assessment of cellulite in vivo was performed by dermatological grading and ultrasound measurements.

RESULTS

Mature adipocytes treated with combined actives resulted in a significant synergistic increase in free glycerol release. On "aged" fibroblasts, combined treatment of F. vesiculosus and F. lumbricalis stimulated pro-collagen I production. CLA increased pro-collagen I production, but the glaucine mixture had no effect. The clinical study demonstrated a significant improvement in cellulite grading by a dermatologist after 8 and 12 weeks vs. vehicle, and ultrasound imaging showed a significant decrease in fat thickness compared with placebo after 12 weeks.

CONCLUSIONS

Our studies revealed a potent cocktail of ingredients that when combined together can act in vitro to markedly improve lipolysis mechanisms and by way of stimulating pro-collagen I can also have an effect on the surrounding extracellular matrix. The in vitro actions of the ingredients were translated in vivo, where a clinical improvement of cellulite condition was observed.

Análise dos efeitos do ultrassom terapêutico e da eletrolipoforese nas alterações decorrentes do fibroedema geloide

INTRODUÇÃO: A síndrome da desarmonia corporal (SDC) inclui a presença de fibroedema geloide (FEG), adiposidade localizada, aumento de gordura corporal total e flacidez muscular - frequentemente associados - e esses distúrbios estéticos representam uma ameaça à integridade emocional do indivíduo, sendo uma variedade de terapias propostas para o seu tratamento. OBJETIVOS: Avaliar os efeitos do ultrassom terapêutico (UST) e da eletrolipoforese no tratamento das alterações decorrentes do fibroedema geloide. MATERIAIS E MÉTODOS: Foram estudadas 22 voluntárias, com idade entre 17-35 anos, presença de FEG graus 1 e/ou 2 em glúteos, sedentárias e usando anticoncepcional. Previamente foram avaliadas as variáveis de perimetria, sensibilidade, dor, satisfação pessoal, adipometria, avaliação fotográfica e bioimpedância elétrica bipolar. Foram realizadas 10 sessões com UST em 11 das voluntárias e as demais 11 voluntarias receberam tratamento por eletrolipoforese. Todas as técnicas foram aplicadas na região glútea bilateralmente, três vezes por semana, e ao término do tratamento as variáveis foram reavaliadas. Na análise estatística foi aplicado o teste t de Student para verificar a significância entre os resultados obtidos em cada tratamento e entre os tratamentos. O nível de significância estabelecido foi de p < 0,05. RESULTADOS: Não houve diferença estatisticamente significante na perimetria, adipometria e bioimpedância após os tratamentos instituídos. Na avaliação fotográfica houve melhora no aspecto visual do FEG em 68,18% das participantes. A satisfação pessoal aumentou em ambos os grupos (UST p = 0,03* e eletrolipólise p = 0,04*). CONCLUSÃO: Os tratamentos apresentaram melhora no aspecto visual do FEG e na satisfação pessoal, porém não alteraram medidas perimétricas, de adipometria e da bioimpedância.

Adiponectin expression in subcutaneous adipose tissue is reduced in women with cellulite

BACKGROUND

Cellulite, which appears as orange peel-type or cottage cheese-like dimpling of the skin on the thighs and buttocks, is a complex, multifactorial, cosmetic disorder of the subcutaneous fat layer and the overlying superficial skin. Adiponectin is an adipocyte-derived hormone mainly produced by subcutaneous fat that shows important protective anti-inflammatory and vasodilatory effects. We hypothesized that adiponectin expressed in the subcutaneous adipose tissue (SAT) might play a role in the pathogenesis of cellulite. We reasoned that a reduction in the expression of adiponectin - a humoral vasodilator - in the SAT of cellulite areas might contribute to the altered microcirculation frequently found in these regions.

METHODS

A total of 15 lean (body mass index [BMI] < 25 kg/m(2) ) women with cellulite and 15 age- and BMI-matched women without cellulite participated in this study. Real-time reverse transcription polymerase chain reaction (RT-PCR) was used to assess adiponectin gene expression. Plasma adiponectin levels were measured using a commercial enzyme immunoassay kit.

RESULTS

Adiponectin mRNA expression in the SAT of the gluteal region was significantly lower in areas with cellulite compared with those without (12.6 ± 3.1 AU versus 16.6 ± 4.1 AU; P=0.006). However, plasma adiponectin levels did not differ between women with (20.3 ± 7.3 μg/ml) and without (19.3 ± 6.1 μg/ml) cellulite (P=0.69).

CONCLUSIONS

Adiponectin expression is significantly reduced in the SAT in areas affected by cellulite. Our findings provide novel insights into the nature of cellulite and may give clues to the treatment of this cosmetic issue.

Treatment of cellulite based on the hypothesis of a novel physiopathology

Background:

The aim of the current study is to report on a new form of treatment for cellulite based on a novel physiological hypothesis.

Methods:

A novel treatment for cellulite was evaluated in 14 patients aged 19–36 (mean 27.5) years. The only inclusion criterion was clinically diagnosed cellulite, and the exclusion criteria were history of edema, obesity, or any other disease diagnosed during the physical examination. Perimetry was performed at the gluteal fold, at 5 cm and 10 cm below the gluteal fold for both legs, and 5 cm and 10 cm below the navel. Additionally, standard photographs were taken and a questionnaire of satisfaction was applied. The patients were submitted to a treatment regimen of 1.5 hours per day adapted for the treatment of cellulite, consisting of manual and mechanical lymph drainage and cervical stimulation using the Godoy and Godoy technique. After 10 sessions over two weeks, the patients were evaluated again.

Results:

Reductions were identified at both points below the navel, the points on the thighs, and at the gluteal fold (P < 0.0001).

Conclusion:

This technique of lymphatic system stimulation is efficacious in the treatment of cellulite.

Benefit of a topical slimming cream in conjunction with dietary advice

Synopsis

The aim of this study was to determine how worthwhile it would be to combine a newly developed topical slimming product with customized dietary habits not based on calorie restriction, so as to improve the cellulite appearance of the skin. At the beginning of the study, a nutritionist recorded the dietary habits of each participant and gave recommendations to each of them according to their food consumption. The chosen methodology was a right/left comparison, one thigh and hip being treated with the new topical slimming product and the other one left untreated to serve as a random control. Objective evaluations were performed by blind assessors. Control of food intake improved the cellulite score after 4 weeks when compared with the base value, but this reduction was significantly greater and earlier on the treated side than on the untreated side, indicating an objective additional benefit derived from the new slimming cream. This result corroborated the slimming effect assessed by measurement in centimetres of the circumference of the upper thighs and the reconstructed volume of the thigh between two fixed horizontal slices. Furthermore, skin tonicity, a major component of cellulite visibility, was also significantly improved on the treated side after only 2 weeks.

This new topical cream thus enhances the benefit of a dietetic control for the treatment of the visible aspect of cellulite on the skin.

Résumé

Cette étude avait pour objectif d’étudier l'intérêt éventuel d'associer une nouvelle crème amincissante à des conseils nutritionnels personnalisés, non basés sur la restriction calorique mais sur un meilleur équilibre alimentaire afin d'améliorer l'aspect cellulitique de la peau. Au début de l’étude un médecin nutritionniste a enregistré les habitudes alimentaires de chaque sujet et a donné des recommandations à chacun en fonction de leur consommation alimentaire. La méthodologie contrôlée en hémi corps, gauche/droite a été choisie, une cuisse, une fesse ayant été traités par le produit à l’étude, l'autre partie du corps étant restée sans traitement selon la randomisation. Les évaluations objectives ont été réalisées par des investigateurs en aveugle. Le contrôle des aliments a permis une réduction du score de cellulite après 4 semaines mais cette réduction est statistiquement plus importante et plus rapide du côté traité avec le produit topique que du côté non traité, ce qui correspond à un effet additionnel objectivé du produit topique. Ce résultat est conforté par l'effet amincissant évalué par la mesure centimétrique de la circonférence de la partie supérieure de la cuisse et l’évolution du volume reconstruit de la cuisse entre deux niveaux. De plus la tonicité de la peau, composante importante de la visibilité de la cellulite, est améliorée significativement dès 2 semaines du coté traité;

Cette nouvelle crème apporte donc un bénéfice complémentaire au contrôle diététique pour le traitement de la cellulite.

Correlation between lumbar lordosis angle and degree of gynoid lipodystrophy (cellulite) in asymptomatic women

INTRODUCTION

Gynoid lipodystrophy (cellulite) has been cited as a common dermatological alteration. It occurs mainly in adult women and tends to gather around the thighs and buttocks. Its presence and severity have been related to many factors, including biotype, age, sex, circulatory changes, and, as some authors have suggested, mechanical alterations such as lumbar hyperlordosis.

OBJECTIVE

To correlate the degree of cellulite with the angle of lumbar lordosis in asymptomatic women.

METHODS

Fifty volunteers were evaluated by digital photos, palpation, and thermograph. The degree of cellulite was classified on a scale of 1-4. Analyses were performed on the superior, inferior, right and left buttocks (SRB, IRB, SLB, ILB), and the superior right and left thighs (SRT, SLT). The volunteers underwent a lateral-view X-ray, and the angle of lumbar lordosis was measured using Cobb's method (inferior endplate of T12 and the superior endplate of S). The data were statistically analyzed using ANOVA and Spearman's correlation. A significance level of 5% was adopted.

RESULTS

Volunteers had a mean age of 26.1+/-4.4 years and a mean body mass index of 20.7+/-1.9 kg/m(2). There was no significant difference in lumbar lordosis angle between those with cellulite classes 2 and 3 (p>or=0.297). There was also no correlation between lumbar lordosis angle and the degree of cellulite (p>or=0.085 and r>or=0.246).

CONCLUSIONS

The analysis suggests that there is no correlation between the degree of cellulite and the angle of lumbar lordosis as measured using Cobb's method.

Impact of extracorporeal shock waves on the human skin with cellulite: a case study of an unique instance

In this case study of an unique instance, effects of medium-energy, high-focused extracorporeal generated shock waves (ESW) onto the skin and the underlying fat tissue of a cellulite afflicted, 50-year-old woman were investigated. The treatment consisted of four ESW applications within 21 days. Diagnostic high-resolution ultrasound (Collagenoson) was performed before and after treatment. Directly after the last ESW application, skin samples were taken for histopathological analysis from the treated and from the contra-lateral untreated area of skin with cellulite. No damage to the treated skin tissue, in particular no mechanical destruction to the subcutaneous fat, could be demonstrated by histopathological analysis. However an astounding induction of neocollageno- and neoelastino-genesis within the scaffolding fabric of the dermis and subcutis was observed. The dermis increased in thickness as well as the scaffolding within the subcutaneous fat-tissue. Optimization of critical application parameters may turn ESW into a noninvasive cellulite therapy.

Kinetics of moisturizing and firming effects of cosmetic formulations

The assessment of cosmetic efficacy is rarely performed in studies comparing different concentrations of active compounds. The aim of the present study was to determine the skin hydrating and the skin firming dose-response effects of cosmetic formulations enriched in compounds derived from algae and fish collagen. A series of factors were studied including the type of formulation (cream or serum), the concentration in active ingredients, the effect of repetitive applications, as well as any residual effect of the formulations after stopping their applications. The serum enriched in marine compounds showed a better moisturizing effect in short term. The cream appeared more active later, particularly following repeat applications. A sustained tensor (firming) effect was observed during treatment with both the lotion and the cream. However, no remnant firming effect was perceived after stopping treatment.

Can cellulite be treated with low-energy extracorporeal shock wave therapy?

The present study investigates the effects of low-energy defocused extracorporeal generated shock waves on collagen structure of cellulite afflicted skin. Cellulite measurement using high-resolution ultrasound technology was performed before and after low-energy defocused extracorporeal shock wave therapy (ESWT) in 21 female subjects. ESWT was applied onto the skin at the lateral thigh twice a week for a period of six weeks. Results provide evidence that low-energy defocused ESWT caused remodeling of the collagen within the dermis of the tested region. Improving device-parameters and therapy regimes will be essential for future development of a scientific based approach to cellulite treatment.

Lipodystrophy reactions to insulin: effects of continuous insulin infusion and new insulin analogs

Management of diabetes mellitus can be responsible for cutaneous adverse events. For example, lipoatrophy or lipohypertrophy can develop at the site of insulin injections. Lipohypertrophy remains a frequent complication of insulin therapy irrespective of the insulin source and mode of administration. Lipoatrophy at insulin injection sites is considered to be an immune complex-mediated inflammatory lesion; however, it has become a rare event since the advent of human insulin. Nowadays, continuous subcutaneous insulin infusion (CSII) using a portable pump and/or injections of insulin analogs with an altered amino acid sequence compared with native insulin may cause lipodystrophy in diabetic patients. Some case reports describe the recovery of lipoatrophy following the use of CSII and/or short-acting insulin analogs. Conversely, exceptional cases of lipoatrophy have occurred in patients receiving lispro insulin analog via CSII. Lipodystrophy reactions remain a potential problem when managing diabetic patients with new insulin therapy technologies.