HOW IS IT DIAGNOSED?
A) Clinical Evaluation And Localisation
The first approach to cellulite must include a thorough clinical history including the time and form of when it first appeared, associated clinical symptoms and identification of predisposing factors.
Cellulitis is mainly diagnosed upon clinical examination.
The examination provides information on the degree, localisation, associated processes (postural disorders, oedema, vascular disorders, etc,) or help establish a differential diagnosis with respect to other processes.
Cellulite sits mainly in the back of the neck, deltoid region, internal aspect of the arms, trochanteric and supratrochanteric regions (love handles and saddlebags), lower abdomen and buttocks, as well as in the internal aspect of thighs and knees.
Whatever the aetiology, localisation and characteristics there are several symptoms and signs common to cellulite: tissue thickening and development of nodes (orange peel skin) and pain due to excessive tissue tension. Direct inspection and the squeezing of subcutaneous tissue establish a simple classification of cellulite into 4 stages:
Moreover, depending on the predominance of one or another etiopathogenic factors (infiltration, fibrosis and adiposis), a classification of cellulite has been proposed as follows: Infiltrative cellulite (superficial hydrolipodystrophy), fibrose cellulite (superficial fibrolipodystrophy) and adipose cellulite (superficial lipodystrophy).
B) Ultrasound Evaluation
Ultrasound as a diagnostic method is not routinely used. However, ultrasound has been of great value to define the different skin structure in people with and without the condition and as an objective validation method of the efficacy of the different treatment modalities available.
High frequency ultrasound differentiates fat tissue of skin, muscle and bone at joining structures, being capable of establishing a water retention index in the tissue. With respect to cellulite it is possible to differentiate the relative importance of the fat overload, fibrosis and water content of the explored skin tissue; differentiation among the three previously described types of cellulite is thus possible with this technique. The images obtained from women with cellulite reveal a scattered pattern of protrusion of underlying adipose tissue towards the dermis. The connective tissue at the dermo-hypodermal border is irregular and discontinues. It has also been shown that the irregular pattern is scattered in affected women and is not exclusively localized in the areas affected with cellulite.
C) Other Complementary Techniques
Thermography: Thermography has been widely used to elaborate a localiser map of affected areas and for the physiopathologic study of cellulite. Ghis showed a thermographic image pattern of cellulite with an alternating pattern of hyperthermal spots and hypothermal spots in “leopard skin” or “mosaic”. Hipólito et al have defined the different progression patterns of cellulite with regard to thermographic images as well as the evaluation of the therapeutic activity of the different treatments.
Magnetic resonance: The skin and subcutaneous fat tissue are very well visualized in images provided by resonance. Furthermore, the changes seen in the cellulite areas (protrusion of fat tissue into the dermis) are clearly shown and correlate extremely well with the degree of cellulite. Magnetic resonance is also capable of showing other parameters such as the percentage of adipose and connective tissue in a certain volume in the hypodermis and the percentage of invaginations that correlate with the degree of cellulite of the patient.