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- Title
THE NODULE OF DISCORD.
- Authors
Terranova, Ferdinando; Iorio, Eugenio Luigi; Amuso, Domenico
- Abstract
The studies about cellulite published by high-impact-factor journals are limited in number and reach antithetical conclusions. Consequently, it is not yet possible to resolve the serious differences among the ideas that, for years, have been dragging on the nature of this disease, on its origin and even on the most basic aspects of its histopathology. It is also lacking a universally recognized name. Over the past decades, five main hypothesis about its pathogenesis have been opposing, with varying success, indicating, as the cause of the imperfection, respectively: 1. an oedema caused by an excessive hydrophilicity of the intercellular matrix; 2. an alteration of the homeostasis at the end of the micro-circulation district; this pathogenic theory is summarized in a concise and explanatory name: edematous-fibrous-sclerotic panniculopathy; 3. the protrusion of intradermal adipocyte hernias, favoured by the peculiar anatomy of the female subcutaneous, different from the male one; 4. the unequal reaction that the fibrous interlobular septa oppose to the stretching induced by the enhanced adipose thickness; 5. the protease-dependent lysis of the fibrous septa. Today, perhaps, all these assumptions are going to be updated in light of recent findings about the sophisticated and complex pathophysiology of adipose tissue, which acts not only as a food surplus store, but also as a con- troller of the energy balance of the entire organism and as multi-hormone endocrine and paracrine system, able to modulate food intake, to regulate the metabolism of caloric substrates in the other districts and to produce a series of additional important systemic actions. The several adipocyte skills make it seem unlikely that this element remains a powerless victim of external factors, when there is a widespread anatomical and functional alteration of the tissue that houses it. The adipose organ, as rightfully today it is named, is distributed in various regions of the body; different deposits show extremely variable dimensions, in relation to caloric balance, gender and age; they manifest very different biological activities, depending on the location and on the expansion.A very wide set of data demonstrates that the upper body adipose fat (i. e. the visceral fat and the subcutaneous fat of the abdominal wall), when in excess, triggers a series of pathogenic mechanisms that provoke, in the tissue, a deep inflammatory remodelling, and, at systemic level, the onset of a complex interweaving of disease states, named metabolic syndrome and including insulin resistance, diabetes, hypertension, dyslipidemia and cardio-vascular atherosclerotic illness. The subcutaneous tissue of the lower limbs is well developed in women, becoming the elective cellulite localization; even when in excess, it does not entail an increased risk of systemic complications, against which seems, in fact, to perform a protective function. Some observations lead, however, to believe that, even in this place, processes of inflammatory remodelling, may occur, capable of contributing to produce the typical alterations of cellulite. The aim of the present review was to provide an update on the pathogenesis of the so-called "cellulite" with a special focus on the emerging role of adipose tissue.
- Publication
European Journal of Aesthetic Medicine & Dermatology, 2015, Vol 3, p10
- ISSN
2240-5046
- Publication type
Academic Journal