So‐Called Cellulite

So‐called cellulite is not a disease in a strict sense. An appropriate term to describe it would be adiposis edematosa. Clinically the condition is characterized by “orange‐peel” skin (enlarged and hyperkeratotic follicular orifices) and the “mattress” phenomenon (flattish protrusions and linear depressions of the skin surface). It is not possible to make an exact distinction between so‐called cellulite and simple obesity. The buttocks and the thighs are the most common sites of the condition. Women of all ages may be affected. When so affected, they complain of a feeling of tightness, heaviness, and tenderness or diffuse spontaneous pain in involved skin. The cause of cellulite, in addition to simple obesity, seems to be the typical inner structure of the subcutis in the female, which is probably dependent on the nature of their hormones. The connection between cutis and subcutis in skin of women displaying the “mattress” phenomenon reveals radial arch‐like structures of the connective tissue, whereas the corresponding structures in males run tangentially. Histologically there are no signs of inflammation. The only pathological changes are slight edema, enlarged lymph vessels in the dermis, and slight degenerative changes in the musculi arrectores pilorum. In the subcutis there is a conspicuous increase in the volume of fat cells. There is no convincing experimental proof of changes in the ground substance of the connective tissue. An increase in the degree of polymerization of the acid glycosaminoglycans has not been shown. For this reason treatment with so‐called “spreading” enzymes does not seem to be rational nor is it indeed effective. Therapy should be restricted to a low‐calorie diet and physiotherapy in the form of exercises, massage, and sports.