title: Efficacy of cosmetic products in cellulite reduction: systematic review and meta-analysis.
abstract: BACKGROUND
  The number of original articles investigating the efficacy of cosmetic products in cellulite reduction increased rapidly in the last decade; however, to our knowledge, no systematic review and meta-analysis has been performed so far.
  
  
  OBJECTIVE
  We conducted a systematic review of in vivo studies on humans adopting the PRISMA guidelines. Moreover, we used a meta-analytic approach to estimate the overall effect of cosmetic creams in cellulite treatment from controlled trials with more than 10 patients per arm, using thigh circumference reduction as the outcome measure.
  
  
  METHODS
  Medline and Embase were searched up to August 2012 to identify eligible studies.
  
  
  RESULTS
  Twenty-one original studies were included in the present systematic review. All studies were clinical trials, most of them recruited women only and 67% had an intra-patient study design. About half of the active cosmetic creams tested only contained one active ingredient among xanthenes, herbals or retinoids. The other studies tested cosmetic creams with more complex formulations and most of them included xanthenes. A total of seven controlled trials satisfied the inclusion criteria for the meta-analysis. The pooled mean difference of thigh circumference reduction between the treated and the controlled group was -0.46 cm (95% confidence intervals, CI: -0.85, -0.08), with significant heterogeneity between studies (P < 0.001).
  
  
  CONCLUSIONS
  This article provides a systematic evaluation of the scientific evidence of the efficacy of cosmetic products in cellulite reduction and supports a moderate efficacy in thigh circumference reduction.
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Department of Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Turati
authors.forename: C
authors.initials: C
authors.lastname: Pelucchi
authors.forename: F
authors.initials: F
authors.lastname: Marzatico
authors.forename: M
authors.initials: M
authors.lastname: Ferraroni
authors.forename: A
authors.initials: A
authors.lastname: Decarli
authors.forename: S
authors.initials: S
authors.lastname: Gallus
authors.forename: C
authors.initials: C
authors.lastname: La Vecchia
authors.forename: C
authors.initials: C
authors.lastname: Galeone
mesh_terms: D000273:Adipose Tissue; D003358:Cosmetics; D005260:Female; D006801:Humans
chemical_list: D003358:Cosmetics