PEFS: Edematous Fibro Sclerotic Panniculopathy

1. PEFS (Edematous Fibro Sclerotic Panniculopathy), commonly and incorrectly known as « cellulite », is characterized by imperfections caused by the alteration of subcutaneous tissues accompanied by morphofunctional alteration of adipose cells.

2. The water retention that characterizes PEFS is due to an alteration of the venous and lymphatic system, which slows the flow of blood causing fluid stasis in the intercellular spaces of the hypodermis. The resulting cellular strain (hypoxia) progressively leads to fibrosis and sclerosis of the tissue: any intervention must therefore be aimed at metabolic correction.

3. PEFS is a pathology and as such must be diagnosed by a doctor and treated by health professionals, who can also train patients in terms of a self-massage technique between treatment sessions.

4. Massage and hydrotherapy are essential cornerstones of PEFS treatment strategies, regardless of the characteristics of the topical preparation prescribed.

5. PEFS is caused by primary and secondary factors (overweight, vascular diseases, endocrine diseases, pregnancy, drug use, sedentary lifestyle, cigarette smoking, chronic constipation, constricting clothing) and as such requires a multidisciplinary approach among specialists (endocrinologists, nutritionists, gynaecologists, dermatologists, vascular surgeons, cosmetic surgeons, posturometrists, psychologists, etc.) coordinated according to the founding criteria of aesthetic medicine, an internal medical branch, aimed at improving the psychophysical balance of the individual through the aesthetic perception of the self.

6. Medical, masso hydrotherapy and instrumental strategies in the treatment of PEFS must always be accompanied by adequate lifestyle improvement, which must be systematically monitored with the patient by a doctor and healthcare professionals, and through periodic updates.

7. The classic stages of PEFS has four successive phases which highlight a progressive anatomical-functional deterioration but normally, in the same affected person, different areas can be characterized by different evolutionary stages: the treatment strategies must therefore not be ad personam but must be localized and this aspect should be explained to patients.
Stage I (edema): Alteration of capillary permeability, felt by the patient as a « sense of weight » in the lower limbs, but accompanied by signs of edematous areas.
Stage II (adipocyte modification): Progressive increase in edema and compression of adipocytes and initial loss of tissue elasticity.
Stage III (fibrosis): imperceptibly, tissue fibrosis and widespread vascular alterations appear. The tissue is « pasty » on palpation, the skin begins to feel cold and sometimes painful; on palpation and with the use of ultrasound the presence of nodules of modest size is noted with connective branches which are no longer straight but sinusoidal. « Orange peel » skin. The irreversibility process begins.
Stage IV (advanced fibrosis and sclerosis): evident tissue fibrosis and sclerosis, with systematic pain on palpation and ultrasonographically, the presence of macronodules and discontinuous sinusoidal connective branches is noted. “Quilted” skin. Irreversible, disabling stage.

8. The diagnosis of PEFS, which should exclusively be carried out by members of the medical profession, must comprise a physical examination as well as an instrumental evaluation (contact thermography) which allows the highlighting of « cold » areas, indicative of metabolic intolerance, typical of this pathology and not a simple localized adiposity, in order to establish early treatment.

9. Instrumental strategies in the treatment of PEFS (Pressotherapy, C.P.A. Booster, Tecar therapy, use of electro-medical instruments, etc.) must be prescribed and followed by a doctor, such as massage therapy and be carried out by highly qualified and validated health personnel who regularly follow courses to familiarize themselves with new treatments.

10. Intrusive (mesotherapy) and surgical interventions must be decided by the doctor only in particularly serious cases and according to the general clinical situation, accompanied by the psychological evaluation of the impact of PEF on the quality of life at an associative level.