Adipocytes are the most representative cells of the adipose tissue. For a long time adipocytes have been defined as no more than "fat guys", passively occupying large body regions, often with undesirable cosmetic effects. The apparent structural uniformity of adipose tissue contrasts with the functional complexity that may be documented at different anatomical sites. A growing body of scientific evidence is telling us that adipose tissue is a very sophisticated organ regulating both energy storage and metabolic management of our body, as well as the main branches of immune system. The adipose tissue is strictly linked with our brain and regulates other organ systems. Adipose tissue paracrine activity regulates turnover, regeneration homeostasis of epidermis, dermis and cutaneous appendages. Adipokines, molecules produced by adipocytes play an important role in many skin disease other than in systemic diseases. This review will focus on the pathophysiology of the adipose tissue with special emphasis on recent scientific acquisitions. Improving our knowledge on fat tissue is necessary to develop interesting new perspectives and therapeutic strategies for both systemic and cutaneous diseases.