TREATMENT OF CELLULITE BASED ON THE HYPOTHESIS OF A NOVEL PHYSIOPATHOLOGY
The presence of cellulite is an esthetically unacceptable cosmetic problem for most postadolescent women.1 Cellulite, or so-called “orange peel” skin affects 80%–90% of all females. It is not considered as a pathological condition but as esthetically disturbing dimpling of the skin, seen most commonly on the thighs and buttocks.2 Cellulite is an alteration of the topography of the skin that occurs in body areas where fat deposits seem to be under the influence of estrogen, mainly the hips, buttocks, thighs, and abdomen. There is currently no cure or consistently effective treatment for cellulite.3 In fact, no treatment is completely successful, and none are more than mildly and temporarily effective.4 This condition is not specific to overweight women, although increased adipogenicity will exacerbate the condition. It is a complex problem involving the microcirculatory system and lymphatics, the extracellular matrix, and the presence of excess subcutaneous fat that bulges into the dermis.1
PHYSIOPATHOLOGICAL HYPOTHESIS OF CELLULITE
A series of questions are asked concerning this condition including as regards to its name, the consensus about the histopathological findings, physiological hypothesis and treatment of the disease. We established a hypothesis for cellulite and confirmed that the clinical response is compatible with this hypothesis. Hence this novel approach brings a modern physiological concept with physiopathologic basis and clinical proof of the hypothesis. We emphasize that the choice of patient, correct diagnosis of cellulite and the technique employed are fundamental to success.
LIPEDEMA: IS AESTHETIC CELLULITE AN AGGRAVATING FACTOR FOR LIMB PERIMETER?
The first description of lipedema was in 1940 by Allen and Hines, who defined it as an abnormal deposit of adipose tissue in the lower limbs with the involvement of the feet that affects women with a family history of the disease. Some characteristics of this physical condition are deposition of excess fat on the legs (described classically as an “Egyptian column” shape) and arms with a negative stemmer sign. A histological analysis of the tissue shows proliferation of progenitor cells derived from adipose tissue and an increase in adipogenesis leading to necrosis of adipocytes and hypoxia. Studies evaluating changes in the lymphatic system in lipedema showed that lymphatic vessels are dilated in lipolymphedema and have obstructive features with dermal reflux and in lipedema the vessels are dilated but without signs of reflux.
IS LYMPHOSTASIS AN AGGRAVANT OF LIPEDEMA?
A 54-year-old female patient reported that a characteristic of her family was ‘fat legs’ with postural edema since adolescence. Over the years the patient had been gaining weight with an increase in fatty tissue in the legs and arms. At the age of 24 years she started taking oral contraceptives and noted worse swelling and pain in the lower limbs. She was advised to suspend the use of the contraceptives and to start using a transdermal lymphatic system drug and physical exercise which partially improved the symptoms. Three years ago she noted that the swelling was increasing without improvement and sought a physician who raised the hypothesis of lymphedema and referred her to a specialized center. Lipedema and lymphedema was diagnosed in the physical examination. A 3-day intensive treatment program (8 h daily) was started for lymphedema which included manual and mechanical lymph drainage associated with short-strech (
EVALUATION OF THE PREVALENCE OF CONCOMITANT IDIOPATHIC CYCLIC EDEMA AND CELLULITE
The aim of this study was to evaluate the prevalence of concomitant idiopathic cyclic edema with Grade II and III cellulite. All patients treated for Grade II and III cellulite were evaluated for idiopathic cyclic edema in a retrospective, quantitative and cross-sectional study. The study was carried out at the Godoy Clinic in the period from 2006 to 2010. All patients with body mass indexes > 25, Grade I cellulite and other causes of edema were excluded. The diagnosis of idiopathic cyclic edema was based on a clinical history and fluid retention throughout the day, in particular difficulty in removing rings on waking in the morning which improves later in the day. All patients with cyclic edema were treated with 75 mg aminaphtone three times daily. Statistical analysis con-sidered the frequency of edema. Of the 82 women evaluated with ages between 18 and 58 years old (mean of 34.9 years) 41 (50.0%) were diagnosed with idiopathic cyclic edema. Idiopathic cyclic edema is an aggravating factor for cellulite and is frequently associated with the more advanced stages of the disease. Its control is essential in the treatment of cellulite.
AMINAPHTONE IN IDIOPATHIC CYCLIC OEDEMA SYNDROME
Idiopathic cyclic oedema syndrome was identified in 1955 by Mach and is a group of clinical conditions that exhibit a vascular capillary hyperpermeability accompanied by oedema caused by interstitial retention of fluid. 1 Excessive weight gain can occur in this disease of unknown aetiology, however, there are hypotheses that hyperaldosteronism, primary abnormalities of the hypothalamus, dopaminergic activity and capillary sphincter control may contribute in some patients.2,3 This is a self-limiting benign disorder, which more commonly affects women and it is characterized by great variations in body weight during the same day. It is seen in women during their fertile period of life, with oedema of the legs and ankles and occasionally the eyelids, face and abdomen.4,5 There are few published studies reporting this disease. The objective of the current study was to evaluate
the efficacy of aminaphtone in the treatment of idiopathic cyclic oedema syndrome.