Insights Into the Pathophysiology of Cellulite: A Review.

BACKGROUND: The etiology of cellulite is unclear. Treatment of cellulite has targeted adipose tissue, dermis, and fibrous septae with varying degrees of success and durability of response. OBJECTIVE: Results from clinical trials that target different anatomical aspects of cellulite can provide insights into the underlying pathophysiology of cellulite. MATERIALS AND METHODS: A search of the PubMed database and ClinicalTrials.gov website was conducted to identify clinical trials that have investigated treatments for cellulite. RESULTS: A lack of trial protocol standardization, objective means for quantification of improvement and reported cellulite severity, and short-term follow-up, as well as variation in assessment methods have made comparisons among efficacy studies challenging. However, the lack of durable efficacy and inconsistency seen in clinical results suggest that dermal or adipose tissue changes are not the primary etiologies of cellulite. Clinical studies targeting the collagen-rich fibrous septae in cellulite dimples through mechanical, surgical, or enzymatic approaches suggest that targeting fibrous septae is the strategy most likely to provide durable improvement of skin topography and the appearance of cellulite. CONCLUSION: The etiology of cellulite has not been completely elucidated. However, there is compelling clinical evidence that fibrous septae play a central role in the pathophysiology of cellulite.

Cellulite: Patient Selection and Combination Treatments for Optimal Results-A Review and Our Experience.

BACKGROUND: More than 90% of women have reported concerns of cellulite on their skin. Both commercially advertised creams and topical pharmacological agents have shown limited improvement. Thus far, there has been a paucity of thorough review articles on how to address and treat this condition. OBJECTIVE: To investigate how the etiology and pathogenesis of cellulite can help guide treatment combinations and provide a more algorithmic approach to comprehensively address a condition that affects so many women. MATERIALS AND METHODS: A review of the literature surrounding treatment options for cellulite and the authors' experience in this area are provided. CONCLUSION: This review summarizes available treatment options for cellulite, including topical agents, controlled subcision, energy-based devices, dermal fillers, and new injectable medications. Furthermore, the various ways that these treatments can be combined in an algorithmic and sequential approach based on the degree of volume loss, skin laxity, and excess adiposity associated with cellulite are addressed. These combination therapies for cellulite are supported both in the published literature and the authors' experience to help clinicians tailor a comprehensive treatment plan for the multiple factors that contribute to cellulite. Further clinical trials are needed to compare various devices and techniques for cellulite as well as combination treatments.

Updates on the understanding and treatment of cellulite.

Cellulite is a common dermatologic condition and frequent cause of cosmetic concern among women. This paper aims to update what is known about the pathogenesis of cellulite and reviews targeted treatment modalities that address its underlying components of microvascular dysfunction, endocrine-mediated inflammation, and connective tissue fibrosclerosis.

Cellulite: a review of pathogenesis-directed therapy.

Cellulite is a condition that affects the majority of postpubertal women and can negatively impact quality of life. This review discusses several proposed pathophysiologies of cellulite, and examines treatment options that have been utilized, focusing on the etiologic factor targeted by the therapies. This approach aims to help clarify the pathogenesis of cellulite and provide a road map for developing effective treatment paradigms for patients.

Treatment of bruising after injection to reduce cellulite.

BACKGROUND: Cellulite 80%-98% of post-pubertal women and results in cutaneous dimples in the affected area. AIMS: Therapies that target collagenous fibrous septae often provide successful outcomes. MATERIALS & METHODS: Collagenase clostridium histolyticum-aaes (CCH) for injection consists of two collagenases which, under physiologic conditions, disrupt collagen structures by hydrolyzing Type I and III collagen. RESULTS: Subcutaneous CCH was approved in the United States in 2020 for the treatment of moderate-to-severe cellulite in the buttocks of adult women. Although bruising is primarily an aesthetic concern, a conspicuous procedure-induced bruise may limit a patient's social activities and result in hesitation to undergo a similar cosmetic procedure in the future. CONCLUSION: The purpose of this review is to describe the available techniques for hastening bruise resolution and how they apply to resolving bruises associated with a CCH injectable.

Limited dilute lidocaine anesthesia: A useful technique with many practical applications.

BACKGROUND: Limited dilute lidocaine infiltration facilitates a comfortable procedure and a rapid recovery process following a novel intervention for reduction of cellulite. Infiltration of dilute lidocaine has many other practical applications in dermatologic surgery. OBJECTIVES: This article describes a safe, effective technique for local infiltration of limited volume dilute lidocaine anesthesia in a cellulite reduction procedure. METHODS: The limited dilute lidocaine technique was utilized in studies of a novel device designed to reduce the appearance of cellulite by focal release of fibrous septa in a minimally invasive procedure. No sedation was used. A small (27- to 30-gauge) needle was used to deliver anesthesia to the entry sites. Then, a 20-gauge spinal needle was tunneled under the skin in the superficial plane to manually deliver anesthetic along the advancement pathway of the device and marked cellulite targets. RESULTS: During the initial studies, the mean delivered anesthesia volume was 357.2 ml (range, 250-525 ml) or 18.7 mg/kg (range, 11.1-28.4 mg/kg). The mean anesthesia time was 16 min (range, 8-32 min). The mean number of cellulite depressions treated was 19.8 (range, 11-34). Adverse events were closely monitored, and there were no signs of toxicity in any study patients. There were very low levels of discomfort; all patients reported the procedure was tolerable. This technique facilitates a time-efficient procedure and minimizes weeping of excess fluid during recovery. CONCLUSIONS: When administered with care and skill, the limited dilute anesthesia technique is a safe, effective approach for local anesthesia with many practical applications in dermatologic surgery.

Cellulite: Presentation and management.

BACKGROUND: 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 esthetic concern, cellulite is now considered a pathological entity with systemic associations and a negative psychological impact on patients. AIMS: The objective of this article was to discuss etiology, pathophysiology, and treatment of cellulite. MATERIALS AND METHODS: Literature was screened to retrieve articles from PubMed/Medline and Google Scholar and related websites. Cross-references from the relevant articles were also considered for review. Review articles, clinical studies, systematic reviews, meta-analysis, and relevant information from selected websites were included. RESULTS: Several treatment options from lifestyle modifications and 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. DISCUSSION: Methodological differences in the trials conducted make it difficult to compare different treatment modalities. CONCLUSION: Overall, treatment needs to be individualized based on the patient characteristics and severity of the condition. A combination of treatments is often required in most patients for reducing cellulite.

Characterization and Pharmacological Evaluation of Anti-Cellulite Herbal Product(s) Encapsulated in 3D-Fabricated Polymeric Microneedles.

Skin health is vital for a healthy body. Herbal remedies have long been used for skin care, and their global use has tremendously increased over the past three decades. Although cellulite is seen as a normal condition by the medical community, it is considered a serious cosmetic concern for most affected women. Many topical anti-cellulite creams are available on the market, but unfortunately, their efficacy has not been proven scientifically. Microneedles (MNs) represent a new approach to enhance the permeation of loaded medication through the skin. In this study, the anti-cellulite effects of Vitex agnus-castus and Tamarindus indica extracts were compared using safe and effective polymeric MNs. This delivery system offers a painless alternative to the combined treatment strategy of microneedling devices and anti-cellulite products. The selected standardized extracts were evaluated for their mineral, phenolic and flavonoid contents, which are correlated to a promising antioxidant effect, as demonstrated by an in vitro radical scavenging activity assay. 3D-printing techniques were chosen for fabrication of a micromold, which is inexpensive for mass production. To ensure that MNs were sufficiently strong to perforate the skin without breaking, axial failure force was measured using a micro-mechanical test machine. The anticellulite effects of MNs were assessed using an in vivo diet-induced obesity guinea pig model. Skin properties, histopathology and inflammatory markers were examined. MNs loaded with plant extracts were statistically comparable in normalizing the oxidative state and reducing inflammation, while myeloperoxidase levels were more significantly reduced by T. indica than by V. agnus-castus. This novel delivery system opens the door for new transdermal strategies for cellulite management.

Evidence-based treatment for gynoid lipodystrophy: A review of the recent literature.

Gynoid lipodystrophy (GLD) is a structural, inflammatory, and biochemical disorder of the subcutaneous tissue causing alterations in the topography of the skin. Commonly known as "cellulite," GLD affects up to 90% of women, practically in all stages of the life cycle, beginning in puberty. It is a clinical condition that considerably affects the patients' quality of life. It is a frequent reason for consultation, although the patients resort to empirical, improvised, nonevidence-based treatments which discourage and can be a source of frustration not only because of the lack of results but also due to the complications derived from those treatments. In this article, a panel of experts from different specialties involved in the management of this clinical skin disorder presents the results of a systematic literature search and of the consensus discussion of the evidence obtained from different treatments currently available. The analysis was divided into topical, systemic, noninvasive, and minimally invasive treatments.

Hernia inguinal perforada con extenso enfisema en el compartimento anterior del muslo / Perforated inguinal hernia with extensive emphysema in thigh

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Celulitis necrosante estéril en las extremidades de migrantes marinos tras travesías prolongadas / Sterile necrotizing cellulitis in boat immigrants’ limbs after long journeys across the ocean

Fundamento Las Islas Canarias reciben migrantes de origen subsahariano que llegan a la costa tras largas travesías marinas en condiciones adversas. El «pie de patera» es una entidad previamente descrita consistente en un cuadro clínico desarrollado a partir de heridas en los pies que se infectan por estar en contacto con aguas fecales estancadas en el fondo de estas embarcaciones. Describimos un nuevo cuadro clínico, hasta ahora no publicado, consistente en un edema masivo de las extremidades que asocia necrosis de la piel y del tejido celular subcutáneo, respeta el músculo y su etiología no es de origen infeccioso. Material y métodos Diseñamos un estudio descriptivo observacional entre los meses de septiembre del año 2020 y enero del año 2022, ambos incluidos, en el ámbito del hospital de tercer nivel situado en Gran Canaria. Se incluyeron un total de 86 pacientes en una base de datos donde se analizaron 39 variables cualitativas y cuantitativas. Resultados Un total de 16 pacientes desarrollaron el cuadro consistente en una celulitis necrosante estéril. Su fisiopatogenia difiere de la del pie de patera, ya que en todos los casos los cultivos resultan estériles. Conclusiones Como mecanismo responsable, postulamos una teoría inflamatoria derivada del efecto osmótico de la ingesta de agua de mar y/o la reposición agresiva de fluidos a su llegada a los centros hospitalarios donde ingresan con deshidrataciones hipernatrémicas graves. El tratamiento quirúrgico precoz consiste en evacuar el edema mediante incisiones tipo escarotomías, el cual alivia la sintomatología y previene la progresión del cuadro (AU)

Background In the past few years, the Canary Islands received immigrants from sub-Saharan countries that arrive to the coast after long boat trips in extreme adverse conditions. The named «trench foot» is a previously described infectious entity developed after feet wounds that get infected by being in contact with water, urine and excrements in these small and crowded boats. We describe a new clinical entity, not published yet, that consists in massive edema in the extremities associating necrosis of the skin and subcutaneous tissue that characteristically respects the muscle and with a non-infectious etiology. Material and methods A database including 86 patients arrived by boat («patera») from sub-Saharan countries from September 2020 to January 2022 was made and 39 qualitative and quantitative items were analyzed. The Research Unit performed an observational prospective statistical analysis. Results A total of 16 patients developed the entity described as necrotizing cellulitis. Its physiopathology completely differs from the one described in the trench foot, since all the cultures resulted sterile. Conclusions We postulate an inflammatory theory due to the osmotic effect from ingesting sea water and/or the aggressive fluid reposition when they arrive to the emergency room with severe dehydration and hypernatremia. Early surgical evacuation of the edema with escharotomies incisions alleviate the symptoms and prevents progression of the disorder (AU)

Celulitis cervical odontógena / Cervical Cellulitis of Odontogenic Origin

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Incidencia de celulitis facial odontógena en el territorio de Matanzas / Odontogenic Facial Cellulites incidence in the territory of Matanzas

La Celulitis Facial Odontógena es relativamente frecuente, puede convertirse en un grave riesgo vital cuando el tratamiento no es adecuado. Se realizó un estudio observacional, analítico, transversal desde enero 2006 a diciembre 2008. La muestra incluyó 49 pacientes que acudieron o fueron remitidos a los servicios de urgencias con el diagnóstico de CFO. Los niños y jóvenes resultaron los más afectados, así como el sexo masculino. Los dientes incurables y los restos radiculares constituyeron las causas más frecuentes, la región anatómica prevaleciente fue la cavidad bucal. El 51 por ciento de los casos tuvieron diagnóstico de celulitis leves, siendo necesario el ingreso hospitalario para 25 pacientes, los demás tuvieron tratamiento ambulatorio. Se recomienda diseñar una estrategia de intervención para disminuir la incidencia de CFO en el territorio de Matanzas.

The Odontogenic Facial Cellulites is relatively frequent; when the treatment is not right, it can become a serious risk for life. We carried up an observational, analytic, transversal study from January 2006 to December 2008. The sample included 49 patients assisting or remitted to the Urgent Care Services with a diagnosis of Odontogenic Facial Cellulites. The most affected were children and young people, and the female sex. The most frequent causes were teeth that can not be healed and roots remaining; the prevailing anatomic region was the oral cavity. 51 percent of the cases were diagnosed as mild cellulites, being necessary the hospital staying for 25 patients; the rest received home treatment. It is recommended to design an intervention strategy to diminish the incidence of the Odontogenic Facial Cellulite in the territory of Matanzas.

Celulitis con mala evolución en paciente cirrótico / No disponible

No disponible

Celulitis por mordedura de gato: Bergeyella zoohelcum / Cat bite-induced cellulitis: Bergeyella zoohelcum

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Celulitis sinérgica necrotizante como complicación de la recidiva de un carcinoma de vejiga de alto grado en paciente cistectomizado / Tittle

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Complicações orbitárias da rinossinusite aguda: uma nova classificação / Orbital complications of acute rhinosinusitis: a new classification

A rinossinusite é uma doença potencialmente grave, e pode apresentar sérias complicações. As orbitárias são as mais freqüentes, graças às peculiaridades anatômicas desta região, podendo levar à morte em 5 por cento dos casos. Os sintomas variam desde sinais flogísticos periorbitários até proptose do globo ocular, oftalmoplegia e amaurose. OBJETIVOS: Proposição de uma nova classificação para as complicações orbitárias das rinossinusites agudas. MATERIAL E MÉTODO: Revisão de TC e prontuários de 83 pacientes atendidos no Hospital das Clínicas da FMRP-USP, entre os anos de 1995 a 2005, com rinossinusites agudas complicadas. RESULTADOS: Após a revisão das TC e história clínica, foram identificadas em sessenta e seis pacientes, três tipos de complicações orbitárias: celulite orbitária (46,9 por cento), abscesso subperiosteal (40,9 por cento) e abscesso orbitário (12,1 por cento). Dezessete foram considerados como infecções palpebrais, ficando excluídos da nova classificação. CONCLUSÃO: As classificações das complicações orbitárias existentes na atualidade, como a de Chandler, não levam em conta os parâmetros anatômicos da órbita e tornaram-se obsoletas com o advento da TC. Este estudo propõe uma classificação mais concisa e objetiva que ajude a guiar a conduta terapêutica de forma mais linear.

Rhinosinusitis is a severe sickness and may have serious complications. Orbital complications happen more often, due to anatomical particularities and are lethal in 5 percent of patients. They vary from inflammatory signs to proptosis, loss of ocular motility and blindness. AIM: We propose a new classification of acute rhinosinusitis complications. METHODS: A review of 83 patients with CT scan and clinical reports. Patients were evaluated at HCFMRP-USP between 1995 and 2005 and were diagnosed with complicated rhinosinusitis. RESULTS: In sixty-six patients, were identified three types of orbital complications: orbital cellulitis (46. 9 percent), subperiosteal abscess (40. 9 percent) and orbital abscess (12.1 percent). Seventeen were considered as eyelid infections and excluded from this new classification system. CONCLUSIONS: The existing classifications of orbital complications, as Chandler’s, do not consider the orbit’s anatomical characteristics and became obsolete after the development of the CT scan. This study proposes a new, more objective classification to guide the physician in establishing lines of conduct for each case.

Celulitis preseptal y orbitaria en la infancia: respuesta a antibioterapia intravenosa / Preseptal and orbital cellulitis in childhood: response to intravenous antibiotics

Objetivo: Evaluar retrospectivamente la respuesta al tratamiento antibiótico empírico de las celulitis preseptales y orbitarias en niños.Método: Se incluyeron nueve pacientes (cinco hombres y cuatro mujeres) ingresados en nuestro hospital por celulitis preseptal u orbitaria desde octubre-02 a octubre-03.Resultados: Cuatro pacientes (44,4%) respondieron al tratamiento antibiótico empírico (R), y cinco (55,5%) no respondieron (NR) y necesitaron la asociación de un segundo antibiótico para resolver la infección.La presencia de infección respiratoria aguda de vías altas (IRA), fue la enfermedad más comunmente asociada en ambos grupos (R y NR). Sin embargo encontramos dos casos de dacriocistitis aguda en el grupo NR. Cuatro pacientes (44,4%) fueron tratados con cefotaxima iv, y cinco (55,5%) con cefuroxima iv como primera opción empírica. Conseguimos resolución de la infección en tres de cuatro pacientes tratados con cefotaxima. Sin embargo sólo un paciente de los cinco tratados con cefuroxima respondió.Conclusiones: Se ha encontrado una alta prevalencia de dacriocistitis aguda como causa potencial de la celulitis. Los niños con celulitis preseptal y orbitaria respondieron mejor a cefotaxima que a cefuroxima. La presencia de dacriocistitis aguda se asoció a falta de respuesta a la cefuroxima (AU)

Purpose: To evaluate retrospectively the response of preseptal and orbital cellulitis in children to empiric antibiotic treatment. Method: We included nine patients (five male and four female) admitted to our hospital between October 2002 and October 2003 because of preseptal or orbital cellulitis. Results: Four patients (44.4%) responded to empiric antibiotic treatment (R); five (55.5%) did not respond (NR) and required a second antibiotic to resolve the infection. The presence of an upper respiratory infection was the most common associated disease in both groups, R and NR. However we also found two cases of acute dacryocystitis in the NR. Four patients (44.4%) were treated with cefotaxime intravenously with the infection resolving in three of these. Five patients (55.6%) were treated with cefuroxime intravenously as first empiric option, however only one patient responded. Conclusions: We found a high prevalence of acute dacryocystitis as a potential cause of the cellulitis. Children with preseptal and orbital cellulitis responded better to cefotaxime than to cefuroxime. The presence of acute dacryocystitis was associated with a lack of response to cefuroxime (AU)

Celulitis gangrenosa cervical complicada con mediastinitis. Caso clínico / Cervical necrotiziting celullitis complicated with mediastinitis. A case report

Presentamos un caso clínico de celulitis gangrenosa cervical de origen odontógeno que progresó al espacio mediastínico, comentando la importancia de un tratamiento precoz y agresivo (quirúrgico y antíbioterapia endovenosa). Discutimos la necesidad de realizar sistemáticamente traqueostomía, así como el momento de llevar a cabo la exodoncia de las piezas causantes del proceso infeccioso. (AU)