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subcutaneous fat necrosis of the newborn

Friday 11 June 2004

Cutaneous fat necrosis of the newborn

Definition: Subcutaneous fat necrosis of the newborn (SCFN) is a rare disorder with different etiologies. There are no epidemiologic data available for SCFN.

Images

- Subcutaneous fat necrosis of newborn : lobular panniculitis with needle-shaped clefts in radial array

Clinical synopsis

Subcutaneous fat necrosis of the newborn (SCFN) is characterized by painful, firm, erythematous nodules and plaques over the trunk, arms, buttocks, thighs, and cheeks of full-term newborns. Lesions appear in the first or second month of life, resolving within several weeks to months.

SCFN is a self-limiting disease, but may be complicated by hyperlipidemia and severe hypercalcemia; the latter can occur after several weeks and result in seizures, blindness and even death due to infections or cardiac arrest.

Histopathology

A granulomatous infiltrate is formed subsequently. Lesions may calcify and nonrenal absorption of calcium increases.

The exact pathophysiology of SCFN is unknown. Perinatal stress like in aspyhxia, meconium aspiration or hypothermia, followed by skin hypoperfusion may lead to subcutaneous fat necrosis.

The mean differential diagnoses are sclerema neonatorum, histiocytosis and cellulitis; conditions like erythema nodosum, lipogranulomatosis (Farber disease), neurofibromas or sarcomas should be excluded.

Diagnosis of SCFN usually requires a deep skin biopsy which shows patchy areas of fat necrosis, surrounded by a granulomatous infiltrate of lymphocytes, macrophages, and giant cells. Many of the fat and multi-nucleated giant cells contain needle-shaped clefts that often lie in a radial arrangement.

Histopathological differential

- sclerema neonatorum
- post-steroidal panniculitis
- infection panniculitis
- cold panniculitis

References

- Wiadrowski TP, Marshman G. Subcutaneous fat necrosis of the newborn following hypothermia and complicated by pain and hypercalcaemia. Australas J Dermatol 2001;42:207-210.

- Hansen KN, Balslev T, Lyngbye TJ, Olesen B, Ebbesen F. Subcutaneous fat necrosis with hypercalcemia. Ugeskr Laeger 1995;157:5398-5399.

- Craig JE, Scholz TA, Vanderhooft SL, Etheridge SP. Fat necrosis after ice application for supraventricular tachycardia termination. J Pediatr 1998;133:727.

- Chuang SD, Chiu HC, Chang CC. Subcutaneous fat necrosis of the newborn complicating hypothermic cardiac surgery. Br J Dermatol 1995;132:805-810.

- Fernandez-Lopez E, Garcia-Dorado J, de UP, Heras I, Santos-Borbujo J, Armijo M. Subcutaneous fat necrosis of the newborn and idiopathic hypercalcemia. Dermatologica 1990;180:250-254.

- 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;10:271-276.

- Sharata H, Postellon DC, Hashimoto K. Subcutaneous fat necrosis, hypercalcemia, and prostaglandin E. Pediatr Dermatol 1995;12:43-47.

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