Cellulitis

Symptoms

Signs of cellulite directly depend on the degree of its development. At the initial stage, the changes are almost invisible to the naked eye. That is why the condition is often impossible to diagnose immediately. Primary symptoms include a slight roughness of the skin surface, pallor of the skin, a decrease in elasticity and an increase in tissue temperature.

Symptoms change and become more pronounced as the disease progresses. In the later stages of cellulite development, symptoms include:

•    Varicose veins;
•    Pain in the affected tissue area;
•    Coarsening of the skin;
•    Puffiness;
•    Tubercles and nodes under the skin;
•    Pallor of the area.
 

Causes

Cellulite is caused by various factors. Inheritance is one of them. A genetically determined violation of blood flow, lymph outflow and a slowdown in metabolic processes provoke the disease.

Other reasons:

1.    Hormonal disorders. Pregnant women, in the period after childbirth, in menopause often experience manifestations of signs of the disease. Taking oral contraceptives, other contraceptives, chronic stress and depression change the hormonal background. As a result, cellulite develops.

2.    Thyroid dysfunction. Changes affect lipid metabolism, which provokes the deposition of fat.

3.    Bad habits such as alcohol abuse and smoking. As a result, kidney disease develops, which often leads to fluid retention. And this provokes a structural change in the subcutaneous tissue.

4.    Phlebeurysm. This condition interferes with lymphatic drainage and blood flow. Edema appears, and the process of fat formation under the skin starts.

5.    Low activity, overweight, obesity. The reasons follow from one another. With insufficient movement, fat accumulates under the skin tissue, excess weight grows, and cellulite appears.

6.    Rapid weight loss. Rapid, unhealthy weight loss affects the elasticity of the subcutaneous structure, provokes the development of deposits and the appearance of an orange peel.

In addition, anxiety, inability to cope with psychological trauma, sleep disturbances, and malnutrition are risk factors for developing the disease. Women who wear high heels also have an increased risk.

Treatment

Since the development of gynoid lipodystrophy is influenced by many factors and the pathogenesis process includes various interrelated links, it is advisable to use an integrated approach for treatment, taking into account the stage of the disease and the prevailing symptoms.
Physical and mechanical treatments:
Vacuum massage
The use of this type of massage is based on the hypothesis of the development of cellulite due to impaired microcirculation in the affected area and the formation of stagnation and hypoxia here. Vacuum exposure improves microcirculation of massaged areas, provides lymphatic drainage effect, reduces the volume of these areas and increases tissue mobility 
This type of massage includes instrumental and hardware techniques. The former include the use of vacuum cans, the latter - special devices for vacuum massage.
LPG massage is done using a special nozzle that captures a skin area with a vacuum and kneads it with rollers.
According to studies, the effectiveness of the procedure may depend on the operator performing the procedure, as well as on the time, nature and intensity of exposure. 
 Pressotherapy
The essence of this hardware method of exposure is the sequential compression of body parts with the help of a pneumatic massager in the direction of the lymphatic and venous outflow. The method is effective for lymphatic, venous or mixed edema, therefore it can be used as part of the complex therapy of gynoid lipodystrophy.
Electrophoresis
A galvanic current of low strength and low voltage supplied through the electrodes has a positive effect on the tone of smooth muscles. This leads to an increase in vascular tone following their expansion, which may favorably affect local metabolism. In addition, the current allows drugs to pass through the stratum corneum for local action. 

Ultrasound Therapy
High-frequency vibrations in themselves have a thermal and vasodilating effect, and can be used for better penetration of drugs through the skin (phonophoresis).
Cavitation
The ultrasonic cavitation method, which is based on the action of ultrasound, causes the destruction of fat cells and is used for invasive or non-invasive liposuction.
RF Lifting
The essence of the method lies in the thermal effect on the lower layers of the skin using RF electrical impulses. During radiofrequency therapy, remodeling of chaotically located collagen filaments into unidirectional ones occurs by destroying intermolecular hydrogen bonds, followed by the synthesis of new filaments. Unlike most other heat-influencing techniques, RF therapy acts very gently and locally: only skin and subcutaneous fat cells are warmed up.
 Laser Therapy
As with RF therapy, collagen remodeling occurs in the skin matrix, but instead of electrical impulses, the thermal effect of the laser is used. Due to this effect, the visual signs of cellulite are reduced.
Manual Massage
Most often, with gynoid lipodystrophy, intensive mechanical massage and manual lymphatic drainage are used. The technique of lymphatic drainage massage includes light rhythmic effects on the area of the lymph nodes, as well as in the direction of the lymphatic and venous outflow. Manual mechanical massage mainly consists of intensive rubbing, kneading and squeezing techniques. The main effect is to reduce local edema and, as a result, reduce the circumference of massaged areas in the short term.
Instrumental techniques for soft tissue mobilization
Mobilization of soft tissues with the help of special tools (Graston technique, RockBlades) is actively used by chiropractors and chiropractors. These instruments can have a lymphatic drainage effect on tissues with the same effect as with manual massage.

Liposuction
Liposuction is an effective method of modeling the shape of the body. However, its use in the fight against the manifestations of cellulite is not justified, since it often causes complications in the form of an increase in the roughness of the skin surface due to postoperative fibrosis  .
Subcision
The essence of this method is to restore the anatomical structure of subcutaneous fat due to the destruction of connective tissue partitions using a special needle.
Pharmacotherapy
Given the pathogenesis of gynoid lipodystrophy, it is possible to use drugs that affect adipocytes, connective tissue and microcirculation. They can be applied systemically, locally and transdermally (through the skin). 
The greatest proven lipolytic effect is possessed by preparations that contain methylxanthines in their composition. By blocking phosphodiesterase, they contribute to the breakdown of fats and a decrease in the volume of fat cells.
Among the drugs that affect the connective tissue, organic silicon preparations are the most studied. They inhibit the degradation of elastic fibers, and also normalize the hydrophilicity (the ability to absorb water well) of protein glycans of the basement membrane of capillaries. As a result, the permeability of the vascular wall is normalized, which prevents edema and tissue hypoxia. When exposed to fat cells, the synthesis of cyclic adenosine monophosphate is stimulated, which in turn ensures lipolysis.
Cosmetics for home use  
There are many creams, ointments and topical preparations for the treatment of gynoid lipodystrophy. Literature data suggests that the effectiveness of most of them in studies was not determined due to the large variety. Therefore, the use of such drugs is associated with the risk of allergic reactions.
Cryolipolysis
The method is based on cooling the subcutaneous fat and leads to the destruction of fat cells with their further absorption and natural processing by the body.
Lipolitics Injections
Allocate lipolytic drugs of direct and indirect action. The former destroy the fat cell itself, while the latter only trigger processes that lead to the splitting of the fat drop. The action of indirect lipolytics is softer, but the cosmetic effect is less pronounced than that of direct ones.
Wraps
Wraps with warming, cooling or other anti-cellulite agents cause superficial irritation of the skin, which improves microcirculation, accelerates metabolic processes and lymph flow in the problem area. Essential oils can also be used.
The use of collagen
There is a hypothesis that taking collagen restores the firmness and elasticity of the subcutaneous fat, which helps to get rid of irregularities on the skin surface. However, scientific evidence for this hypothesis is insufficient.
Proper nutrition
In combination with other methods, you can use the general principles of rational nutrition. As an independent method of treatment, the diet is not used. There is no specific diet designed to treat cellulite.
Physical activity
A sedentary lifestyle contributes to the accumulation of fat and the development of cellulite. For this reason, physical activity helps fight cellulite.
 

Tests Required for Diagnosis

In addition to the assessment of external manifestations, the diagnosis of cellulite also includes the Ricoux tetrad, which consists of the following signs determined by palpation:
•    Increase in the thickness of subcutaneous tissues;
•    Increase in tissue density;
•    Increased sensitivity and soreness;
•    Decrease in mobility.
Additional research methods can be used to correctly diagnose and evaluate the effectiveness of therapy.
Anthropometry: measuring height, weight, circumferences of various parts of the body, calculating the body mass index. This method allows diagnosing obesity and local fat deposits. However, it cannot be used to assess the degree of gynoid lipodystrophy, since when these indicators change, the degree of cellulite may not change 
Bioimpedance analysis is the measurement of the electrical resistance of body parts in different parts of the body. Allows you to determine the percentage of adipose and muscle tissue, since different tissues transmit electric current in different ways. For example, muscle is much denser than fat. The disadvantage of the method is that it does not assess the functional state of tissues and does not reveal microcirculation disorders in the affected area 
MRI and CT also determine only the volume of adipose tissue, but do not allow assessing the state of the dermis and microcirculation. In this regard, these methods are used only for the diagnosis of obesity 
Thermography is based on the measurement of thermal infrared radiation of the body and gives the true temperature of only the uppermost layer of the skin with a thickness of 2-3 mm. A direct relationship has been established between changes in body surface temperature and the processes occurring in the body. Since the pathogenesis of gynoid lipodystrophy involves microcirculatory changes, thermography is suitable for assessing the severity of cellulite changes.
The disadvantage of this technique is the measurement error due to high sensitivity to various external influences: ambient air temperature, exposure to sunlight, smoking, menstrual cycle phase, etc. 
USG can be used to evaluate changes in gynoid lipodystrophy . When using a sensor with a frequency of 7.5-10 MHz, it is possible to assess the subcutaneous adipose tissue, visualize the nodules, determine their diameter, as well as the state of the surrounding connective tissue. After the advent of sensors with a frequency of 20-30 MHz, it became possible to visualize the papillary and reticular layers of the dermis and establish the presence of edema in this area. The use of Doppler sonography makes it possible to assess the state of the microvasculature of the altered area 
3D optical topography helps to study the microrelief of the skin from the obtained gradient images. The undoubted advantage of this method is its non-invasiveness and simplicity 
Biopsy: The most accurate method for diagnosing the stage of gynoid lipodystrophy is the histological examination of biopsy materials. However, due to its invasiveness, this method cannot be widely used.