Cellulite describes a condition that occurs in men and women where the skin of the lower limbs, abdomen, and pelvic region becomes dimpled after puberty. The term was first used in the 1920s and began appearing in English language publications in the late 1960s, the earliest reference in Vogue magazine,"Like a swift migrating fish the word cellulite has suddenly crossed the Atlantic."

Other descriptive names for cellulite include orange peel syndrome, cottage cheese skin, the mattress phenomenon, and hail damage. Cellulite is not related to being overweight; average and underweight people also get cellulite.

Practically all post-pubescent females display some degree of cellulite. There seems to be a hormonal degree to its presentation. It is rarely seen in males. However things such as Klinefelter's syndrome, hypogonadism, post-castration states and in those patients receiving estrogen therapy for prostate cancer make it more common. For males with androgen deficiency the cellulite gets worse as the condition does.

Causes of Cellulite

What causes cellulite remains to some degree misunderstood although metabolism and physiology changes may cause or contribute. Included in these are a disorder of water metabolism, abnormal hyperpolymerization of the connective tissue, and chronic venous insufficiency.

Hormones play a dominant role in the formation of cellulite. Estrogen is the most important hormone. Hormones seem to aggravate and initiate cellulite. Other hormones such as insulin, the catecholamines adrenaline and noradrenaline, thyroid hormones, and prolactin also have been shown to participate in cellulite development.

Prediposing factors have been shown to be necessary for the development of cellulite. These include gender, race, biotype, a hormone receptor allele that determines the receptor number and sensitivity, distribution of subcutaneous fat, and predisposition to circulatory insufficiency.

Diet and lifestyle has been shown to affect the development and amount of cellulite. Too much fat, carbohydrates, salt, alcohol or too little fiber can all contribute to cellulite development. Smoking, lack of exercise, tight clothes, high heeled shoes, and sitting or standing in a single position of extended periods have all been related with an increase in cellulite. Furthermore a high stress lifestyle also increases catecholamine hormones.

Cellulite Grades

Grade 1 cellulite is no clinical symptoms, but histopathology detects underlying anatomical changes.

The second grade of cellulite is when the skin appears with pallor, lower temperature, and decreased elasticity after compression or muscular contraction. There is no visible "orange peel" roughness to the skin. Histopathology detects more anatomical changes.

There is a visible orange peel roughness to the skin for grade 3 cellulite. Sometimes it is known as the "canonical" grade of cellulite. Thin granulations in the deep levels of the skin can be detected by palpitation. Grade 2 signs are still present but with more anatomical changes are detectable by histopathology.

The last grade 4 cellulite has all the signs of 3 but with more visible, palpable, and painful lumps present which adhere to deep structures in the skin. The skin has a noticeable dimpled, wavy appearance and additional histopathologic changes are detected.

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