Subcutaneous fat necrosis of the newborn
- Raegan Hunt, MD, PhD
Raegan Hunt, MD, PhD
- Assistant Professor of Dermatology and Pediatrics
- Texas Children's Hospital
- Baylor College of Medicine
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 .
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".)
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) .
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 . In many cases of SCFN, the pregnancy was complicated by factors such as maternal diabetes, hypertension or hypothyroidism, preeclampsia, and placental abruption . Although classically a disease of full-term infants, uncommon cases of SCFN in premature neonates have been described .
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 . 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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