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Subcutaneous fat necrosis of the newborn

Author
Raegan Hunt, MD, PhD
Section Editor
Moise L Levy, MD
Deputy Editor
Rosamaria Corona, MD, DSc

INTRODUCTION

Subcutaneous fat necrosis of the newborn (SCFN) is an uncommon panniculitis of neonates. Classically, red, red-brown, or violaceous subcutaneous nodules and indurated plaques develop on the posterior trunk, buttocks, proximal extremities, or cheeks within the first few weeks of life. Although SCFN is a self-limited condition, recognition of this entity is important, as affected infants require monitoring for associated hypercalcemia or other complications. SCFN generally has a good outcome, with spontaneous resolution of skin disease over weeks to months; however, death from hypercalcemia has been reported in several infants with SCFN [1].

The epidemiology, pathogenesis, clinical manifestations, diagnosis, and management of SCFN are discussed here. Sclerema neonatorum, a rare, severe panniculitis that develops in critically ill neonates, is discussed separately. (See "Sclerema neonatorum".)

EPIDEMIOLOGY

Subcutaneous fat necrosis of the newborn (SCFN) is an uncommon condition, and its precise incidence is unknown. For reference, a retrospective study over a 20-year time period at a tertiary referral center identified 30 infants diagnosed with SCFN and reported a nearly equal male-to-female ratio (1.14:1) [2].

Risk factors — SCFN most often develops in full-term (>37 weeks gestational age) neonates who have experienced hypoxia or other perinatal stress. Therapeutic hypothermia with cooling of the body or head for neonatal asphyxia is an additional risk factor [3]. In many cases of SCFN, the pregnancy was complicated by factors such as maternal diabetes, hypertension or hypothyroidism, preeclampsia, and placental abruption [2]. Although classically a disease of full-term infants, uncommon cases of SCFN in premature neonates have been described [4].

PATHOGENESIS

The pathogenesis of subcutaneous fat necrosis of the newborn (SCFN) remains elusive. One hypothesis proposes that SCFN results from the combination of local tissue hypoxia and mechanical pressure; another suggests that the enrichment of stearic acids and saturated palmitic acids in neonatal fat predisposes the tissue to crystallization at low temperatures [1]. As most of the reported cases of SCFN have developed in the setting of hypoxia or hypothermia, these hypotheses are attractive, although the exact pathogenetic mechanisms are unclear.

       

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Literature review current through: Feb 2017. | This topic last updated: Tue Feb 28 00:00:00 GMT 2017.
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References
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  1. Hicks MJ, Levy ML, Alexander J, Flaitz CM. Subcutaneous fat necrosis of the newborn and hypercalcemia: case report and review of the literature. Pediatr Dermatol 1993; 10:271.
  2. Del Pozzo-Magaña BR, Ho N. Subcutaneous Fat Necrosis of the Newborn: A 20-Year Retrospective Study. Pediatr Dermatol 2016; 33:e353.
  3. Hogeling M, Meddles K, Berk DR, et al. Extensive subcutaneous fat necrosis of the newborn associated with therapeutic hypothermia. Pediatr Dermatol 2012; 29:59.
  4. Mitra S, Dove J, Somisetty SK. Subcutaneous fat necrosis in newborn-an unusual case and review of literature. Eur J Pediatr 2011; 170:1107.
  5. Farooque A, Moss C, Zehnder D, et al. Expression of 25-hydroxyvitamin D3-1alpha-hydroxylase in subcutaneous fat necrosis. Br J Dermatol 2009; 160:423.
  6. Kruse K, Irle U, Uhlig R. Elevated 1,25-dihydroxyvitamin D serum concentrations in infants with subcutaneous fat necrosis. J Pediatr 1993; 122:460.
  7. Cook JS, Stone MS, Hansen JR. Hypercalcemia in association with subcutaneous fat necrosis of the newborn: studies of calcium-regulating hormones. Pediatrics 1992; 90:93.
  8. Sharata H, Postellon DC, Hashimoto K. Subcutaneous fat necrosis, hypercalcemia, and prostaglandin E. Pediatr Dermatol 1995; 12:43.
  9. Metz SA, Hassal E. PGE, hypercalcemia, and subcutaneous fat necrosis. J Pediatr 1980; 97:336.
  10. Beuzeboc Gérard M, Aillet S, Bertheuil N, et al. Surgical management of subcutaneous fat necrosis of the newborn required due to a lack of improvement: a very rare case. Br J Dermatol 2014; 171:183.
  11. Thomas JM, Bhandari J, Rytina E, et al. Subcutaneous Fat Necrosis of the Neonate with a Delayed Second Eruption. Pediatr Dermatol 2016; 33:e134.
  12. Mahé E, Girszyn N, Hadj-Rabia S, et al. Subcutaneous fat necrosis of the newborn: a systematic evaluation of risk factors, clinical manifestations, complications and outcome of 16 children. Br J Dermatol 2007; 156:709.
  13. Mahé E, De Prost Y. [Subcutaneous fat necrosis of the newborn]. Ann Dermatol Venereol 2007; 134:494.
  14. Burden AD, Krafchik BR. Subcutaneous fat necrosis of the newborn: a review of 11 cases. Pediatr Dermatol 1999; 16:384.
  15. Shumer DE, Thaker V, Taylor GA, Wassner AJ. Severe hypercalcaemia due to subcutaneous fat necrosis: presentation, management and complications. Arch Dis Child Fetal Neonatal Ed 2014; 99:F419.
  16. Borgia F, De Pasquale L, Cacace C, et al. Subcutaneous fat necrosis of the newborn: be aware of hypercalcaemia. J Paediatr Child Health 2006; 42:316.
  17. Canpolat N, Özdil M, Kuruğoğlu S, et al. Nephrocalcinosis as a complication of subcutaneous fat necrosis of the newborn. Turk J Pediatr 2012; 54:667.
  18. Nair S, Nair SG, Borade A, Ramakrishnan K. Hypercalcemia and metastatic calcification in a neonate with subcutaneous fat necrosis. Indian J Pediatr 2009; 76:1155.
  19. Tran JT, Sheth AP. Complications of subcutaneous fat necrosis of the newborn: a case report and review of the literature. Pediatr Dermatol 2003; 20:257.
  20. Schubert PT, Razak R, Jordaan HF. Fine-Needle Aspiration as a Method of Diagnosis of Subcutaneous Fat Necrosis of the Newborn. Pediatr Dermatol 2016; 33:e220.
  21. Schubert PT, Razack R, Vermaak A, Jordaan HF. Fine-needle aspiration cytology of subcutaneous fat necrosis of the newborn: the cytology spectrum with review of the literature. Diagn Cytopathol 2012; 40:245.
  22. Vasireddy S, Long SD, Sacheti B, Mayforth RD. MRI and US findings of subcutaneous fat necrosis of the newborn. Pediatr Radiol 2009; 39:73.
  23. Srinath G, Cohen M. Imaging findings in subcutaneous fat necrosis in a newborn. Pediatr Radiol 2006; 36:361.
  24. Anderson DR, Narla LD, Dunn NL. Subcutaneous fat necrosis of the newborn. Pediatr Radiol 1999; 29:794.
  25. Weedon D. Panniculitis. In: Weedon's Skin Pathology, 3rd ed, Weedon D (Ed), Churchill Livingstone/Elsevier, Edinburgh 2010. p.1041.
  26. Rapini RP. Practical Dermatopathology, Elsevier Mosby, Philadelphia 2005.
  27. Markus JR, de Carvalho VO, Abagge KT, Percicotte L. Ice age: a case of cold panniculitis. Arch Dis Child Fetal Neonatal Ed 2011; 96:F200.
  28. Zeb A, Darmstadt GL. Sclerema neonatorum: a review of nomenclature, clinical presentation, histological features, differential diagnoses and management. J Perinatol 2008; 28:453.
  29. Akın MA, Akın L, Sarıcı D, et al. Follow-up during early infancy of newborns diagnosed with subcutaneous fat necrosis. J Clin Res Pediatr Endocrinol 2011; 3:216.
  30. Wiadrowski TP, Marshman G. Subcutaneous fat necrosis of the newborn following hypothermia and complicated by pain and hypercalcaemia. Australas J Dermatol 2001; 42:207.
  31. Akin MA, Akin L, Coban D, et al. Post-operative subcutaneous fat necrosis in a newborn: a case report. Fetal Pediatr Pathol 2011; 30:363.